The American journal of emergency medicine
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A pelvic x-ray (PXR) can be used as an effective screening tool to evaluate pelvic fractures and stability. However, associated intra-abdominal/retroperitoneal organ injuries and hemorrhage should also be considered and evaluated in patients with major torso injuries. An abdominal/pelvic computed tomographic (CT) scan may provide higher resolution and more information than a PXR. The role of conventional PXRs was delineated in the current study in the context of the development of the CT scan. ⋯ For the management of patients with major torso injuries, the role of PXR is diminishing due to the development of the CT scan. However, the PXR is still valuable for patients who are in critical condition and have an obviously high probability of retroperitoneal hemorrhaging.
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Jolt accentuation or exacerbation of a baseline headache with horizontal rotation of the neck is a physical finding believed to assess for meningeal irritation. We conducted a prospective observational study of neurologically intact emergency department (ED) patients undergoing lumbar puncture in 2 inner city academic EDs to validate the sensitivity and specificity of jolt accentuation and to assess the sensitivity and specificity of Kernig sign, Brudzinski sign, and nuchal rigidity, in predicting cerebrospinal fluid (CSF) pleocytosis in individuals being assessed for meningitis. Adult patients 18 years and older undergoing lumbar puncture between 2006 and 2009 were approached for consent. ⋯ The specificity of jolt accentuation was 82%, Kernig sign was 97%, Brudzinski sign was 98%, and nuchal rigidity was 80%. Jolt accentuation in our cohort was poorly predictive of pleocytosis and insensitive. The presence of Kernig sign, Brudzinski sign, or nuchal rigidity has moderate positive but no negative predictive value for pleocytosis.
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We assessed out-of-hospital cardiac arrest patients' cerebral oxygenation during cardiopulmonary resuscitation (CPR) using near infrared spectrophotometry (NIRS). We evaluated the relation between a rise in patients' cerebral saturation values between the start and end of CPR and return of spontaneous circulation. ⋯ Patients whose cerebral saturation values measured with NIRS rise during CPR have a higher post-resuscitation survival rate. Monitoring of patients during CPR with this non-invasive technique may be a good method for predicting return of spontaneous circulation.
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Clopidogrel is an adenosine diphosphate receptor antagonist. The risk of intracranial hemorrhage following minor head trauma in patients with pre-injury use of clopidogrel has not been fully determined. ⋯ The use of clopidogrel is associated with a significantly increased risk of developing intracranial hemorrhage following minor trauma.
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Cerebrospinal fluid (CSF) rhinorrhea is rarely seen in the emergency department (ED) and most often occurs after a traumatic event. Spontaneous CSF leaks are much less common and are often the result of benign intracranial hypertension. If not recognized early on, CSF infections are the most serious consequence of this condition and therefore its early diagnosis and treatment are essential. ⋯ This disease must be considered in the differential diagnosis of any patient who presents with persistent atraumatic unilateral rhinorrhea. Although CSF leaks have been portrayed in the literature, this case report is unique because it describes a rare manifestation of this condition and its diagnosis by emergency physicians. This article presents the case, discusses the incidence, potential causes, predisposing factors, diagnostic modalities and the course of treatment for this particular diagnosis.