The American journal of emergency medicine
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Intraoral evaluation with ultrasound has been shown to be an ideal method for differentiating between peritonsillar abscess (PTA) and peritonsillar cellulitis. Unfortunately, many patients experience significant trismus and are unable to tolerate the intracavitary probe. ⋯ We present a case of a 30 year old male patient with severe throat pain and trismus. Ultrasound evaluation of the submandibular space with a linear transducer demonstrated a clear peritonsillar abscess and allowed for successful aspiration of 5 mLs of purulent material.
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The objective of this study was to determine factors that impact emergency department (ED) utilization among the most frequent ED users. ⋯ The top 1% of frequent users usually had adequate health insurance and primary care access but were burdened by chronic conditions and frequent hospital admissions. Such patients may require more extensive coordinated medical management to decrease ED utilization.
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Our aim in this study was to use ultrasonography of internal jugular vein (IJV) instead of visual estimation by eye and to get more precise estimation of central venous pressure at supine position for estimating blood loss in healthy volunteers. ⋯ Although, the IJV collapse index was not found to be a useful parameter for evaluation of hypovolemia, cIJV LL is more valuable marker for the detection of blood loss at bedside.
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During the influenza season patients are labeled as having an influenza-like illness (ILI) which may be either a viral or bacterial infection. We hypothesize that C-reactive protein (CRP) levels among patients with ILI diagnosed with a bacterial infection will be higher than patients diagnosed with an influenza or another viral infection. ⋯ C-reactive protein is both a sensitive and specific marker for bacterial infection in patients presenting with ILI during the influenza season.
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Case Reports
Intracranial hemorrhage with electrocardiographic abnormalities and troponin elevation.
Electrocardiographic (ECG) abnormalities and cardiac troponin I elevation are seen in addition to the classic clinical symptoms and signs of subarachnoid hemorrhage (SAH). We aimed to show that, in patients with ST elevation, troponin elevation, and altered consciousness, the reason may be SAH. A 36-year-old man presented to emergency service with ECG abnormalities, high level of cardiac troponin I, and neurologic symptoms. ⋯ The patient died on the 10th day of follow-up because of severe metabolic acidosis, multiorgan failure, and bradycardia. Cardiac evaluation is recommended in patients with intracranial hemorrhage in many studies. In our opinion, if there are neurologic symptoms or signs in patients diagnosed as acute myocardial infarction with ECG changes and troponin elevation, requesting threshold of brain computed tomography should be low before the thrombolytic therapy.