The American journal of emergency medicine
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Comparative Study
The inadvertent administration of anticoagulants to ED patients ultimately diagnosed with thoracic aortic dissection.
Aortic dissection (AD) may present similarly to acute coronary syndrome or pulmonary embolus; however, anticoagulation may be detrimental to patients with AD. ⋯ There is a clinically significant incidence of anticoagulation administration to ED patients ultimately diagnosed with AD, especially in the presence of ambiguous ECG and radiographic findings.
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Comparative Study
Ultrasound image transmission via camera phones for overreading.
Emergency physicians using ultrasound frequently encounter unfamiliar findings during routine ultrasound examination. This is especially common for less experienced practitioners. ⋯ Ultrasound pictures recorded by one phone and then sent to another yielded images that showed no statistically significant differences from traditional high-resolution thermal printouts in image quality, detail, and resolution. Measurements were too small to be read on the camera phones, and reviewers had statistically significantly lower confidence in their diagnosis when using the camera phones to review images.
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The purpose of the study was to evaluate the use of chest radiography for the screening of severe acute respiratory syndrome (SARS). We retrospectively analyzed all patients who attended an Emergency Department SARS screening clinic during the outbreak in Hong Kong, from March 10 to June 5, 2003. Patients with clinical and epidemiologic suspicion of SARS were evaluated by serial chest radiography. ⋯ The initial radiograph had sensitivity 50.3%, specificity 95.0%, positive likelihood ratio 10.06, negative likelihood ratio 0.52, positive predictive value 61.5%, and negative predictive value 92.3% for diagnosing SARS. Serial chest radiography had sensitivity 94.4%, specificity 93.9%, positive likelihood ratio 15.48, negative likelihood ratio 0.06, positive predictive value 71.4%, and negative predictive value 99.0%. The initial chest radiograph has poor sensitivity, and serial radiographs are required to rule out SARS.
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Determining the different cutoff values of C-reactive protein (CRP) on the basis of how long the patient's symptoms were present can be used to early predict acute appendicitis. We analyzed retrospectively from 2001 to 2004 the hospital records of 568 patients who underwent appendectomies for suspected appendicitis. ⋯ The cutoff values of CRP concentration taken as the first, second, and third days after onset of symptoms that distinguish acute appendicitis from other acute abdominal diseases were 1.5, 4.0, and 10.5 mg/dL, respectively; the values that distinguish perforated appendicitis from other acute abdominal diseases were 3.3 mg/dL (first day), 8.5 mg/dL (second day), and 12.0 mg/dL (third day). The different cutoff values of CRP concentration may serve as a useful predictive parameter in the early diagnosis of acute appendicitis on the first 3 days after the onset of symptoms.
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The purple urine bag syndrome (PUBS) is a rare condition associated with chronic urinary catheterization. It is characterized by the purple discoloration of the urine, collecting bag, and tubing. ⋯ The syndrome resolves usually after treatment of urinary tract infection or changing of the collecting bag. We present a case of a patient with purple urine bag syndrome and a pertinent literature review.