The American journal of emergency medicine
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Dynamic changes in electrocardiographic findings between initial and follow-up electrocardiograms (ECGs) have rarely been studied for disease severity and differential diagnosis in non-ST elevation acute coronary syndrome. We aimed to determine whether the changes in staple variables on ECG can assist in distinguishing between neuropsychiatric or gastrointestinal disorders (mild non-ischemic disorders), heart failure, and NSTE-ACS (non-ST elevation acute coronary syndrome). ⋯ The maximum changes in the T/QRS ratio in two contiguous leads can assist in distinguishing disease severity and acute mimicking disease such as acute heart failure in patients with suspected ACS.
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The COVID-19 pandemic compelled healthcare systems to rapidly adapt to changing healthcare needs as well as identify ways to reduce COVID transmission. The relationship between pandemic-related trends in emergency department (ED) visits and telehealth urgent care visits have not been studied. ⋯ During initial COVID surges, ED visits declined while telehealth visits rose in inverse correlation with falling ED visits, suggesting that some patients shifted their preferred location for clinical care. As EDs cope with future staffing during the ongoing COVID pandemic, telehealth represents an opportunity for emergency physicians and a means to align patients desires for virtual care with ED volumes and staffing.
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Given signs and symptoms of hyperthyroidism are non-specific, thyroid studies may be completed to evaluate patients with vague complaints such as tachycardia in the emergency department (ED). We sought to determine how often a new diagnosis of hyperthyroidism was made in patients who underwent thyroid laboratory testing in the ED. ⋯ This study suggests that thyroid laboratory studies may be best used for a focused assessment for thyroid disorders rather than a screening tool for patients with one symptom of hyperthyroidism.
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Pericardial tamponade is critical clinical diagnosis that requires prompt management and intervention. However, it is unknown if early pericardiocentesis is associated with better or worse patient outcomes. ⋯ Early pericardiocentesis was associated with decreased 1-year survival. Future prospective analysis adjusting for patients' complexities is required.
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While there is ample data supporting the use of barbiturates and benzodiazepines (BZDs) for the treatment of alcohol withdrawal, there is a paucity of information on treating recurrent withdrawal among high healthcare utilizing patients. The purpose of this study was to assess the efficacy and safety of phenobarbital (PB), with or without adjuvant BZDs, for treatment of acute alcohol withdrawal in the emergency department (ED) in patients with high rates of recurrent withdrawal. ⋯ Among patients with multiple visits presenting with alcohol withdrawal, treatment with PB, BZDs, or both did not result in significantly different rates of admission or readmission within 48 h. Receiving a combination of PB and BZDs was associated with significantly longer ED length of stay, more ICU care, and increased incidence of hypotension as compared to either PB or a BZD alone.