The American journal of emergency medicine
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The purpose of this study was to determine whether long-term and short-term changes in cardiac troponin T (cTnT) were associated with adverse cardiac events (ACEs) in patients with chronic kidney disease. Long-term changes were defined as changes in cTnT between ED visits, and short-term changes were defined as changes between 2 consecutive serial cTnT measurements within an ED visit. A retrospective chart review of patients with chronic kidney disease with suspected acute coronary syndromes presenting to the ED between December 1999 and November 2003 was conducted. ⋯ To evaluate the clinical significance of acute changes in cTnT, a secondary analysis was performed on 64 patients with an initial cTnT measurement above 0.10 ng/mL. For in-hospital and 30-day ACE, a short-term increase in cTnT of 0.11 ng/mL had a positive likelihood ratio of 13.3 and 11.9, respectively. Long-term and short-term increases in cTnT are associated with an ACE.
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The objective of this study was to assess effectiveness of gum elastic bougie (GEB) in case of difficult intubation occurring in the prehospital settings. After manikin training to GEB handling, physicians were recommended to use GEB as first alternative technique in case of difficult intubation. Intubating conditions and details of patients requiring GEB-assisted laryngoscopy were recorded over 30 months. ⋯ Twenty-four (60%) GEB patients had associated factors for difficult intubation such as reduced or limited cervical spine mobility, morbid obesity, cervicofacial trauma, and ears, nose, and throat neoplasia. The success rate of GEB was 75% and 94%, respectively, depending on whether associated factors for difficult intubation are present or not. No adverse events associated to GEB use were noted.
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Fournier gangrene is a life-threatening infection of the scrotal skin. Although originally thought to be an idiopathic process, Fournier gangrene has been shown to have a predilection for patients with diabetes as well as chronic alcohol abuse; however, it can also affect patients with nonobvious immune compromise. Because of potential complications, it is important to diagnose the disease process as early as possible. ⋯ In patients with low to moderate suspicion of Fournier gangrene, it may provide a rapid and reliable diagnosis and differentiate the pathological process from mimicking entities such as scrotal edema or cellulitis. We present 6 cases of Fournier's gangrene diagnosed in the ED at the patient's bedside using ultrasound. None of the patients had a history of diabetes, and 5 had sources of infection determined.
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Ocular trauma can occur from isolated facial trauma or in major blunt trauma such as motor vehicle accidents or falls. Despite the etiology of the injury, a thorough evaluation is important but may often be difficult if severe swelling is present. ⋯ Literature suggests that unsuspected and difficult to diagnose pathology may be easily detected on ultrasound of the orbit. We present 3 cases of isolated facial trauma in which routine evaluation with ocular ultrasound led to the discovery of periorbital air with one patient having air insufflating the upper lid of the affected side.
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Compression fracture of the vertebral body is common, especially in older adults. Injuries to the spinal column are one of the most frequent injuries by accidents and falls from heights. Vertebral fracture associated with minor trauma, however, is a rare occasion. ⋯ Drivers should be strongly warned and educated on the potential hazards of traversing past such bumps in roads too fast and such barriers should be built regarding tested standards.