The American journal of emergency medicine
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Observational Study
Clinical features of patients inappropriately undiagnosed of pulmonary embolism.
The objective of this study was to identify clinical factors associated with delayed diagnosis of acute pulmonary embolism (PE) in the emergency department (ED). ⋯ Delay in diagnosis of acute PE is frequent despite current diagnostic strategies. Patients are sent home or admitted to hospital with a wrong diagnosis depending on clinical presentation or coexisting medical conditions.
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Despite the usefulness of the Cincinnati Prehospital Stroke Scale (CPSS) for rapid recognition of acute stroke, its ability to assess stroke severity is unclear. We investigated the usefulness of CPSS for assessment of stroke severity by comparing CPSS and National Institutes of Health Stroke Scale (NIHSS) scores in patients who were candidates for thrombolytic therapy at hospital admission within 6 hours of symptom onset. ⋯ The CPSS is an effective prehospital stroke scale for the determination of stroke severity and identification of candidates for thrombolytic therapy.
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Case Reports
Good neurologic recovery after cardiac arrest using hypothermia through continuous renal replacement therapy.
Therapeutic hypothermia (TH) is becoming a standard of care to mitigate neurologic injury in cardiac arrest survivors. Several cooling methods are available for use in TH. For maintaining a target temperature, intravascular cooling is superior to, more efficacious than, and safer than surface cooling methods. ⋯ Continuous renal replacement therapy has been widely used in the intensive care unit to improve clinical parameters and survival in patients with multiple-organ dysfunction of septic origin. Continuous renal replacement therapy can also be used as another type of core cooling method. We used continuous renal replacement therapy as a cooling method to induce TH in a patient who had a cardiac arrest, and the patient regained consciousness 52 hours later.
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Comparative Study
Differences of postresuscitation myocardial dysfunction in ventricular fibrillation versus asphyxiation.
This study aims to characterize postresuscitation myocardial dysfunction in 2 porcine models of cardiac arrest (CA): ventricular fibrillation cardiac arrest (VFCA) and asphyxiation cardiac arrest (ACA). ⋯ Compared with VFCA, ACA causes more severe cardiac dysfunction associated with less successful resuscitation and shorter survival time.
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Behçet's disease is a multisystemic, potentially life-threatening condition with vascular involvement and thrombotic tendency. The disease course is characterized by exacerbations and remissions. Lower extremity vein thrombosis is the most frequent manifestation of vascular involvement, followed by vena cava thrombosis, pulmonary artery aneurysms, peripheral artery aneurysms, dural sinus thrombosis and abdominal aorta aneurysms. The case in this report was considered worth reporting due to vena cava thrombosis extending from brachiocephalic to jugular vein, accompanying thrombosis of the contralateral brachiocephalic vein and jugular veins as well as simultaneous dural sinus thrombosis, and also benefit from thrombolytic therapy.