The American journal of emergency medicine
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Randomized Controlled Trial
Exploring differential response to an emergency department-based care transition intervention.
To identify multivariable subgroups of patients with differential responses to a nurse-delivered care transition intervention after an emergency department (ED) visit in a randomized controlled trial (RCT) using an emerging data-driven method. ⋯ Although exploratory, the results of the MoB analysis suggest that patient factors related to social relationships such as marital status may be important contributors to differential response to a care transition intervention after an ED visit. These were characteristics that the investigators had not anticipated or planned to examine in the individual prespecified subgroup analysis. Data-driven methods can yield unexpected findings and contribute to a more complete understanding of differential treatment effects in subgroup analysis, which can inform further work on development of effective care transition interventions in the ED setting.
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Head injuries are an important problem in pediatric emergency care. The majority of head injuries are mild. Even when abnormalities are noted on computed tomography (CT), most patients have good outcomes. We aimed to evaluate the clinical course of pediatric patients who had head injuries and Glasgow Coma Scale (GCS) scores of 15, in whom abnormal findings were noted on head CT, to determine the impact of radiographic features on the need for hospitalization and clinical progression. ⋯ Pediatric head injuries with GCS scores of 15 may rarely require surgical intervention, even when CT shows abnormalities. In particular, patients diagnosed with isolated skull fracture or subarachnoid hemorrhage on CT may not require routine hospitalization. A validation study is needed to confirm the findings of this study.
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Case Reports
Cholinergic crisis caused by ingesting topical carpronium chloride solution: A case report.
A cholinergic crisiss is a state characterized by excess acetylcholine owing to the ingestion of cholinesterase inhibitors or cholinergic agonists. We report the first case of a cholinergic crisis after the ingestion of a carpronium chloride solution, a topical solution used to treat alopecia, seborrhea sicca, and vitiligo. An 81-year-old woman with no prior medical history was transported to our emergency department because the patient had disturbance of consciousness after ingesting three bottles of FUROZIN® solution (90 mL, 4500 mg as carpronium chloride). ⋯ On the second day of admission, the patient was examined by a psychiatrist and discharged without suicidal ideation. Carpronium chloride has a chemical structure similar to that of acetylcholine; therefore, it exhibits both cholinergic and local vasodilatory activities. There is limited information on the pharmacokinetics of ingested carpronium chloride; therefore, physicians should be made aware that ingesting a carpronium chloride solution may cause a cholinergic crisis.
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Carbon monoxide poisoning is a toxicological emergency that causes neurological complications. High serum neurogranin can be detected in acute or chronic conditions where brain tissue is damaged. This study aimed to investigate the diagnostic value of serum neurogranin level and its role in demonstrating neurological damage in patients admitted to the emergency department with carbon monoxide poisoning. ⋯ Serum neurogranin level may be a new diagnostic biomarker in patients admitted to the emergency department with carbon monoxide poisoning. The high serum neurogranin levels detected in patients with normal diffusion-weighted imaging after carbon monoxide poisoning suggest that there is neurological damage in these patients, even if imaging methods cannot detect it.
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Case Reports
Indirect signs of aortic dissection on POC-TTE despite an ADD-RS of 0 and D-dimer < 500 ng/mL: A case report.
Aortic dissection (AD) is a "can't miss" diagnosis for emergency physicians. An algorithm combining the Aortic Dissection Detection Risk Score (ADD-RS) with D-dimer has been proposed as a high-sensitivity clinical decision tool for AD that can determine the need for advanced imaging. Here we present a case of a 48-year-old male who presented to the emergency department (ED) with chest pain and dyspnea. ⋯ The patient successfully underwent surgical repair. This case demonstrates that the ADD-RS + D-dimer algorithm would have erroneously ruled out AD, without the inclusion of indirect findings of AD from the POC-TTE. This highlights the value of using POC-TTE as an adjunct to the ADD-RS + D-dimer algorithm in the diagnostic evaluation of AD and how giving more weight to indirect signs of AD on POC-TTE could potentially increase the sensitivity of the combined ADD-RS + D-dimer + POC-TTE algorithm.