The American journal of emergency medicine
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The value of electrocardiogram (ECG) overreads of emergency department (ED) tracings have been questioned in the literature. This review was designed to assess the validity of this criticism. ⋯ Official cardiology overreads seldom affect the clinical outcome of patient care delivered in the ED setting.
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The American Heart Association/American Stroke Association guidelines recommend all patients presenting to emergency departments (EDs) with a potential stroke be seen within 10 minutes of arrival, although this may not be achieved in all patients. We sought to identify factors associated with delayed evaluation of ED patients with potential stroke. ⋯ In this national sample of patients presenting with strokes to US EDs, patient visits to metropolitan statistical area hospitals and those triaged to less urgent categories were associated with delayed evaluation.
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Case Reports
Good outcome after intravenous thrombolysis for acute stroke in a patient under treatment with dabigatran.
The novel oral anticoagulants (NOACs) are indicated for stroke and systemic embolism prophylaxis in patients with nonvalvular atrial fibrillation (AF). Very few cases of intravenous recombinant tissue plasminogen activator (IV rt-PA) in patients under treatment with NOACs have been described. ⋯ We describe an unusual case of treatment IV rt-PA for acute ischemic stroke in a patient receiving dabigatran for AF. The decision to treat the patient with IV rt-PA was based on the combination of normal coagulation times with the long time elapsed after the last dose of dabigatran, when the drug effect was predictably residual.
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Ultrasound of the inferior vena cava (IVC) is a noninvasive and rapidly obtainable method of intravascular volume assessment; however not all patients can lie supine for this procedure. In this study we assess whether patient positioning affects IVC diameter metrics. ⋯ IVC metrics do not change significantly based on patient position. For those patients who are unable to lay completely supine, a semi-upright measurement of the IVC for volume status may be an accurate alternative.
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Case Reports
A misdiagnosis of clonorchiasis as gallstone, leading to an unnecessary cholecystectomy: a case report.
This case report describes an unusual presentation of Clonorchissinensis infection. In this rare case, a clonorchiasis infection that had been latent for decades was misdiagnosed as acute calculous cholecystitis. Exploratory surgery and a cholecystectomy were performed. Therefore,in the course of diagnosis of hepatic and gall diseases, we cannot neglect parasite infections such as clonorchiasis.