The American journal of emergency medicine
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Case Reports
Traumatic splenic laceration with delayed rupture secondary to coughing in a patient with Von Willebrand disease.
We describe the case of a 54-year-old male with Von Willebrand Disease who presented to the Emergency Department (ED) with 2 weeks of worsening abdominal pain after falling on his left flank while boating. On his initial presentation, he was found to have a Grade II splenic injury that was managed non operatively by the trauma service. Four days later, he returned to the ED when he developed severe abdominal pain after coughing and was found to have active extravasation from the splenic parenchyma with hemoperitoneum on CT angiography and a grossly positive FAST exam. Intraoperatively, he was found to have a Grade V splenic injury and subsequently underwent splenectomy.
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Comparative Study
Pulmonary embolism and COVID-19: A comparative analysis of different diagnostic models performance.
Pulmonary embolism (PE) is a common complication of SARS-CoV-2 infection. Several diagnostic prediction rules based on pretest probability and D-dimer have been validated in non-COVID patients, but it remains unclear if they can be safely applied in COVID-19 patients. We aimed to compare the diagnostic accuracy of the standard approach based on Wells and Geneva scores combined with a standard D-dimer cut-off of 500 ng/mL with three alternative strategies (age-adjusted, YEARS and PEGeD algorithms) in COVID-19 patients. ⋯ None of the diagnostic prediction rules are reliable predictors of PE in COVID-19. Our data favour the use of a D-dimer threshold of 500 ng/mL, considering that higher thresholds increase specificity but limits this strategy as a screening test.
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Acute heart failure (HF) exacerbation is a serious and common condition seen in the Emergency Department (ED) that has significant morbidity and mortality. There are multiple clinical decision tools that Emergency Physicians (EPs) can use to reach an appropriate evidence-based disposition for these patients. ⋯ This article discusses evidence-based disposition of patients in acute decompensated HF presenting to the ED. Knowledge of these factors and risk tools can assist emergency clinicians in determining appropriate disposition of patients with HF.
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Randomized Controlled Trial
Effectiveness of lidocaine spray on radial arterial puncture pain: A randomized double-blind placebo controlled trial.
Radial arterial puncture is a painful procedure. The aim of this study was to evaluate the effect of lidocaine spray (10%) on pain associated with radial artery blood withdrawal for arterial blood gas analysis. ⋯ The level of pain perceived during radial arterial puncture was significantly lower in those who were administered lidocaine spray. Lidocaine spray application can be used in pain management related to radial arterial puncture.