The American journal of emergency medicine
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Early recognition of left ventricular hypertrophy is important because antihypertensive treatment decreases morbidity and mortality. The ideal screening method for left ventricular hypertrophy in hypertensive emergency department (ED) patients has not been identified. Our objective was to determine the diagnostic accuracies of electrocardiogram (ECG) and N-terminal Pro-B-type natriuretic peptide (pro-BNP) for left ventricular hypertrophy individually and in combination in hypertensive ED patients. ⋯ The combination of ECG and pro-BNP is a promising screening algorithm for identification of hypertensive ED patients with left ventricular hypertrophy.
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A delay in diagnosis of sepsis and appropriate treatment increases subsequent mortality. An association with the degree of bandemia, or the presence of immature neutrophils in the white blood cell count, has not been explored in septic patients presenting to the emergency department (ED). We hypothesized that the presenting band levels would be higher in septic patients who die in hospital compared with survivors. ⋯ The band level on presentation was not found to be associated with inpatient mortality in ED patients with sepsis who are eligible for early goal-directed therapy.
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Case Reports
Delayed enterothorax and hepatothorax due to missed right-sided traumatic diaphragmatic rupture.
Traumatic diaphragma ruptures (DRs) are an unusual condition after blunt thoracoabdominal trauma, and there are some difficulties in the diagnosis, in the absence of the additional life-threatening injuries. Right-sided injuries are less frequent than left-sided injuries and may be missed easily. ⋯ Particularly, to our knowledge, progressive hepatothorax and enterothorax that develop over years are a very rare presentation of DR. Herein, we present a case of progressive thoracic herniation of the abdominal organs, diagnosed 22 years after the initial trauma.
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Acute upper gastrointestinal hemorrhage (UGIH) is a common reason for hospitalization with substantial associated morbidity, mortality, and cost. Differentiation of high- and low-risk patients using established risk scoring systems has been advocated. The aim of this study was to determine whether these scoring systems are more accurate than an emergency physician's clinical decision making in predicting the need for endoscopic intervention in acute UGIH. ⋯ The clinical use of risk scoring systems in acute UGIH may not be as good as clinical decision making by emergency physicians.
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Colonoscopy is generally a safe and effective means to detect, diagnose, and treat colonic abnormalities. Although the overall complication rate is low, the morbidity and mortality following perforation approach 50%. ⋯ This is a seldom occurrence and may result following bowel perforation with the rapid accumulation of free air into the peritoneal cavity. It is a life-threatening complication and a surgical emergency.