The American journal of emergency medicine
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Variation in computed tomography (CT) use between emergency medicine (EM) physicians may delineate appropriate or inappropriate use. We hypothesize that variation in all types of CT use exists between providers and their use in patients with common chief concerns. We determine EM physicians' variability in CT use of all types and whether high use in one area predicts use of other CT types. ⋯ We demonstrate a dramatic variation in CT use among EM physicians in all types of CT and common chief concerns. Greater variation was present in patients who were discharged. Large deviation from the mean by a group of providers may suggest inappropriate use.
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It is known that patients with convulsion often present hyperammonemia. The elevation of ammonia levels in convulsion is considered to occur along with extensive muscle contractions, but the details remain unclear. In emergency pathologies, such as cardiopulmonary arrest or hemorrhagic shock without muscle contraction, red blood cells are known to produce ammonia through acidosis, leading to hyperammonemia. A similar effect would be considered to be involved in idiopathic epileptic seizure patients as well. ⋯ Idiopathic epileptic seizures can present with prominent hyperammonemia with acidosis. Because high ammonia level in epileptic seizure was strongly correlated with pH and BE, we speculate that hyperammonemia is not only because of extensive muscle contractions but is also related to ammonia production in the red blood cells through acidosis like other emergency conditions.
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The aim of this study was to investigate the factors affecting in-hospital mortality among geriatric trauma patients who presented to the emergency department (ED) following a motor vehicle collision. ⋯ In our study, heart failure, cranial trauma, abdominal trauma, pelvic trauma, and ISS were found to be the most important predictors of in-hospital mortality among geriatric motor vehicle trauma patients.
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The aim of the study was to evaluate the epidemiology and outcome after cardiac arrest caused by intoxication. ⋯ Cardiac arrest caused by intoxication is found predominately in young patients. Overall, favorable neurologic survival was achieved in 34%. Opiate-related cardiac arrest was associated with poor survival and a high incidence of neurologic deficits.
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Salicylate poisoning classically results in an increased anion gap metabolic acidosis. We discuss a case of normal anion gap metabolic acidosis despite elevated serum salicylate concentration. ⋯ In emergency department settings, high level of clinical suspicion for salicylate poisoning should be maintained, and metabolic acidosis with normal anion gap should not be used to rule out salicylate overdose. This can prevent significant avoidable morbidity and mortality.