The American journal of emergency medicine
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Early aggressive resuscitation in patients with severe sepsis decreases mortality but requires extensive time and resources. This study analyzes if patients with sepsis admitted through the emergency department (ED) have lower inpatient mortality than do patients admitted directly to the hospital. ⋯ Admission for sepsis through the ED was associated with lower early and overall inpatient mortality in this large national sample.
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The elderly are particularly sensitive to delirium-inducing medications. We report a case of a 93-year-old woman who developed anticholinergic delirium from subcutaneous diphenhydramine that she received in the emergency department. ⋯ Diphenhydramine use is associated with a high incidence of anticholinergic adverse effects, especially in the elderly. Clinicians should carefully consider using diphenhydramine in this vulnerable population.
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Comparative Study
The diagnostic accuracy of an abdominal radiograph with signs and symptoms of intussusception.
The objective of this study was to compare the diagnostic accuracy of an abdominal ultrasound to that of a highly suggestive abdominal radiograph combined with signs and symptoms of intussusception. ⋯ Ultrasound is not needed before an enema for the diagnosis of intussusception for those with a highly suggestive abdominal radiograph, abdominal pain, lethargy, and vomiting.
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The aim of this study was to define the nature of metabolic acidosis in patients with septic shock on admission to intensive care unit (ICU) using Stewart method. We also aimed to compare the ability of standard base excess (SBE), anion gap (AG), and corrected AG for albumin and lactate (AGcorr) to accurately predict the presence of unmeasured anions (UA). ⋯ Patients with septic shock exhibit a complex metabolic acidosis at ICU admission. High UA may be present with normal values of SBE and [HCO3-] as a result of associated "relative" hypochloremic alkalosis. Corrected AG for albumin and lactate offers the most accurate bedside alternative to Stewart calculation of UA.
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Hyperlactatemia may be associated with poor outcome in patients with ischemic stroke because it reflects a state of tissue perfusion. This study aims to know whether initial hyperlactatemia in the emergency department (ED) is associated with poor outcome in patients with ischemic stroke. ⋯ Among patients with ischemic stroke, initial hyperlactatemia represents an independent risk factor for poor outcome after controlling for stroke severity, risk factors, initial glucose level, and interval from onset of stroke symptoms to ED arrival.