The American journal of emergency medicine
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Multicenter Study
Pulmonary Embolism Rule-out Criteria vs D-dimer testing in low-risk patients for the diagnosis of pulmonary embolism: a retrospective study in Paris, France.
The Pulmonary Embolism Rule-out Criteria (PERC) score has shown excellent negative predictive value; however, its use in the European population with high prevalence of PE is controversial. In Europe, PERC is not part of routine practice. For low-risk patients, guidelines recommend D-dimer testing, followed if positive by imaging study. We aimed to study the rate of diagnosis of PE after D-dimer testing in PERC-negative patients that could have been discharged if PERC was applied. ⋯ D-dimer testing in PERC-negative patients led to a diagnosis of PE in 0.5% of them, with 15% of patients undergoing unnecessary irradiative imaging studies.
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Case Reports
Spontaneous hepatic rupture caused by hemolysis, elevated liver enzymes, and low platelet count syndrome.
The causes of hemolysis, elevated liver enzymes, and low platelet count (HELLP) syndrome or hepatic hemorrhage as a serious complication of HELLP are not known. Although spontaneous hepatic rupture associated with HELLP syndrome is a rare complication of pregnancy, hepatic rupture results in life-threatening complications. ⋯ Hepatic rupture in HELLP syndrome should be considered a differential diagnosis in pregnant patients with sudden onset of abdominal pain or hypotension. We report a case of 30-year-old primigravida female with spontaneous hepatic rupture caused by HELLP syndrome as a presenting symptom of right upper quadrant abdominal pain.
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Stroke has been rarely associated with carbon monoxide (CO) intoxication. We report a symptomatic internal carotid artery (ICA) thrombosis in a patient with acute CO intoxication.
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Case Reports
Primary umbilical endometriosis presenting as umbilical drainage in a nulliparous and surgically naive young woman.
Endometriosis is well known as a chronic condition associated with significant morbidity. Umbilical endometriosis, however, may go unrecognized because of its rarity, leading to multiple medical visits and a delayed diagnosis. Chronic umbilical drainage is an unusual presentation for umbilical endometriosis. ⋯ There are very few published case reports about primary umbilical endometriosis. A 24-year-old nulliparous African American woman presents to the emergency department with a complaint of chronic umbilical drainage of 3-year duration and undergoes a computed tomographic scan and subspecialty referral, which lead to the diagnosis of primary abdominal wall endometriosis and a new left ovary endometrioma. Although this is an unusual occurrence, it may be considered in patients with chronic umbilical drainage without other cause.
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Randomized Controlled Trial Comparative Study
A comparison of suprascapular nerve block and procedural sedation analgesia in shoulder dislocation reduction.
Dislocation of the shoulder joint is one of the most common dislocations. The reduction procedure is a painful procedure. In this study, 2 different treatment groups were compared for pain control during shoulder dislocation reduction. It was aimed to evaluate the differences between the groups in reduction, success, length of hospital stay, complications, side effects, patient-physician satisfaction, and ease of application. ⋯ Suprascapular nerve block, which can be easily applied under USG in the ED, can be evaluated as a good alternative to SA in the reduction of shoulder dislocations.