The American journal of emergency medicine
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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.
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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.
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Acute appendicitis, characterized as periumbilical pain, migrating to the right iliac fossa, is one of the most common acute surgical conditions. It is usually diagnosed on the basis of clinical signs and symptoms. ⋯ We report this first case of acute appendicitis who presented initially with complain of diarrhea accompanying hypokalemia. There have been no published data suggesting its existence in any parts of the world.
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An 80-year-old woman presented to the emergency department with failure to thrive and weakness for 14 days. Medical history was significant for polio. On admission her electrocardiogram showed atrial flutter, and cardiac enzymes were elevated. ⋯ She underwent hernia repair. After surgery, the patient was taken off rate control and monitored for 72 hours; she did not have any episode of atrial flutter and was discharged with follow up in a week showing no arrhythmia. Her flutter was caused directly by the mechanical effect of the large hiatal hernia pressing against her heart, as the flutter resolved after the operation.
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Case Reports
The evaluation of acute vision loss: a case report of central serous chorioretinopathy.
Acute vision loss is frightening to patients and may represent serious pathology that is irreversible if not intervened upon quickly. We present a case of a 36-year-old man with sudden onset of unilateral painless central visual disturbance described as flashes of light. ⋯ Although there is no proven treatment regimen for acute disease, vision problems usually resolve. Some patients have recurrent episodes that can lead to permanent visual loss