The American journal of emergency medicine
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Colonoscopy is a commonly performed medical procedure generally considered safe and effective. Rare complications include postpolypectomy bleeding and perforation. A far less common and more unusual complication is splenic injury. ⋯ The mechanism of such injury is not known but has been hypothesized to be either traction on the splenocolic ligament or previously formed adhesions, direct blunt injury, or special maneuvers used to advance the colonoscope. Patients typically present with severe abdominal pain less than 24 hours after the procedure and may demonstrate Kehr's sign. Computed tomographic imaging is the diagnostic method of choice, and suspicion of splenic injury should necessitate careful observation with potential for operative intervention.
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Radiation sialadenitis is an uncommon adverse reaction to radioactive iodide therapy. Sialadenitis due to radiation exposure has a dose-related damage that can follow an acute or chronic inflammatory nature. We present a case of a patient who developed radiation sialadenitis after radioactive iodide therapy for papillary thyroid cancer resulting in severe parotid swelling and swelling, which resulted in an emergency department visit and had complete resolution with conservative management.
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Multicenter Study Clinical Trial
Combined copeptin and troponin to rule out myocardial infarction in patients with chest pain and a history of coronary artery disease.
The main objective of this multicentric study was to evaluate the additional value of copeptin to conventional cardiac troponin (cTn) for a rapid ruling out of acute myocardial infarction (AMI) in patients with acute chest pain and a previous history of coronary artery disease (CAD). ⋯ In triage patients with acute chest pain lasting for less than 6 hours and a previous history of CAD, the combination of copeptin and cTn allows for the ruling out AMI, with a negative predictive value greater than 95%.
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A myriad of hospital-wide initiatives have been implemented with the goal of decreasing door-to-balloon time. Much of the evidence behind the common strategies used is unknown; multiple strategies have been suggested in the reduction to the use of this important time-sensitive intervention. Among 8 primary strategies, 2 have substantial evidence to support their implementation in the attempt to reduce door-to-balloon time in ST-segment elevation myocardial infarction (STEMI), including emergency physician activation of the cardiac catheterization laboratory and prehospital activation of the STEMI alert process. ⋯ Although all the STEMI systems of care reviewed are associated with a decreased in time to treatment, only a few have sufficient quantitative evidence to support their implementation. To be effective, the movement to decrease time to treatment of STEMI at any hospital must be composed of an institutional response that includes multiple disciplines. Success also requires active participation from nurses, members of the catheterization team, and hospital leadership.