The American journal of emergency medicine
-
Case Reports
Cecal pneumatosis intestinalis in obstructing sigmoid cancer in ED: Emergency metallic stenting.
An 85-year-old man presented with acute abdomen. Abdominal computed tomography revealed obstructing sigmoid colon cancer with pneumatosis intestinalis of the ascending colon. A surgeon was consulted for colonic obstruction with impending sepsis, who declined surgery considering the patient's advanced age. ⋯ Normal stool passage was achieved after this, and the patient survived the 9-month follow-up period. Acute colonic obstruction from obstructive colon cancer requires emergency management, wherein the presence of pneumatosis intestinalis poses a high risk of cecal perforation. Emergency endoscopic colonic metallic stent placement provides an alternative therapy, particularly when surgery is not feasible, as described here.
-
Comparative Study
Senior patients with moderate to severe pain wait longer for analgesic medication in EDs.
Delayed pain treatment is a common problem in emergency departments (EDs). The objective of this study was to examine the effect of age on time to ED patients receiving the first analgesic dose for moderate to severe pain. ⋯ Seniors with moderate to severe pain wait 1.1 hours (55.2%) longer than younger patients to receive analgesics. Physicians and nurses (32 and 35 minutes, respectively) contributed to this disparity.
-
Mid-regional pro-atrial natriuretic peptide (MR-proANP), procalcitonin (PCT), and mid-regional pro-adrenomedullin (MR-proADM) demonstrated usefulness for management of emergency department patients with dyspnea. ⋯ In patients admitted for dyspnea, assessment of PCT plus MR-proADM improves risk stratification and management. Combined use of biomarkers is able to predict in the total cohort both rehospitalization and death at 30 and 90 days.
-
Comparative Study
Outcome and adverse events with 72-hour cooling at 32°C as compared to 24-hour cooling at 33°C in comatose asphyxial arrest survivors.
Studies suggest that the current therapeutic hypothermia (TH) protocol does not improve outcomes in adult asphyxial arrest survivors. We sought to compare the effect of 24-hour cooling at 33°C vs that of 72-hour cooling at 32°C on outcomes and the incidence of adverse events in unconscious asphyxial arrest survivors. ⋯ The present study did not demonstrate an advantage of 72-hour cooling at 32°C in unconscious asphyxial arrest patients compared with 24-hour cooling at 33°C.
-
High-sensitivity troponin (HS-TnT) combined with copeptin have been proposed to expedite the diagnostic exclusion of acute myocardial infarction. The Global Registry of Acute Coronary Events (GRACE) has been validated and recommended by the European Society of Cardiology as a prognostic score in the management of acute coronary syndrome (ACS) without ST-segment elevation (non-ST+) on the electrocardiogram. Our study examined whether a low GRACE score (<108) combined with negative HS-TnT (<14 ng/L) and copeptin (<14 pmol/L) reliably exclude the diagnosis of non-ST+ ACS, including non-ST-segment elevation myocardial infarction and unstable angina. ⋯ A negative copeptin associated with a negative HS-TnT in a patient presenting with a low GRACE score expedited the diagnostic exclusion of non-ST+ ACS.