The American journal of emergency medicine
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QTc dispersion in the electrocardiogram (ECG) is a new important prognostic factor for many diseases, but its role in intracerebral hemorrhage (ICH) is not clear. This study was performed to investigate the prognostic significance of QTc dispersion in the acute ICH patients. We studied the differences of QTc dispersion from the initial ECG in the ED between the survival to discharge and nonsurvival patients retrospectively. ⋯ The QTc dispersion and GCS were the statistically significant independent predictors in the multiple logistic analyses. Increased QTc dispersion in the initial ED electrocardiograph is an important prognostic factor for ICH patients. More attention to the disposition and intensive care should be given for these patients.
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Randomized Controlled Trial Multicenter Study Comparative Study Clinical Trial
Efficacy of accelerated dose titration of olanzapine with adjunctive lorazepam to treat acute agitation in schizophrenia.
We conducted a prospective double-blind study of accelerated dose titration of olanzapine in the treatment of newly admitted acutely agitated patients with schizophrenia. Patients were randomized to either oral olanzapine (10 mg per day) or oral haloperidol (10 mg per day), plus lorazepam as needed (up to 12 mg per day). ⋯ Significant within-group improvement was demonstrated in PANSS Agitation scores for both groups as early as 1 hour after initiating therapy (-5.79 +/- 6.30 for olanzapine and -4.89 +/- 6.05 for haloperidol, P <.001). This study demonstrated that accelerated dose titration of oral olanzapine is as efficacious as oral haloperidol in reducing acute agitation in patients with schizophrenia.
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The purpose of this study was to evaluate the door-to-needle time for fibrinolytic administration for acute myocardial infarction (AMI) at Vancouver General Hospital (VGH) and identify factors associated with time prolongation. A retrospective chart review of all patients fibrinolysed for AMI in the ED at VGH was performed from January 1, 1998, to December 31, 1999, to determine door-to-needle time. A mixed-effects linear regression model was fit to the fibrinolytic data with the door-to-needle time to identify factors associated with prolonged times. ⋯ Patients who arrived during the night shift (2300-0700 hrs) had significantly shorter door-to-needle times than those patients who arrived during the day (0700-1500 hrs) or afternoon (1500-2300) shifts (P = 0481); and patients who had a longer time from chest pain onset to ED arrival also had longer door-to-needle times (P =.0233). A significant number of AMI patients fibrinolysed at VGH do not meet the national guideline for door-to-needle time less than 30 minutes. Factors associated with this should be addressed to improve the care of patients with AMI.
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The purpose of this study was to demonstrate the computed tomography (CT) features of pulmonary tuberculosis in patients with acute clinical manifestations. The emergent CT images of 46 non-AIDS patients with acute clinical presentations of pulmonary tuberculosis (TB) were analyzed. The distribution and characterization of the pulmonary and pleural lesions were specifically focused. ⋯ On followup, 12 patients (26%) developed acute respiratory failure. Patients presenting with multifocal pulmonary consolidation, with or without cavitations, on CT should undergo early pulmonary TB workup. These findings could help early detection for pulmonary TB.
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Hepatic portal venous gas (HPVG) is a rare radiographic finding of significance. Most cases with HPVG are related to mesenteric ischemia that have been associated with extended bowel necrosis and fatal outcome. With the help of computed tomography (CT) in early diagnosis of HPVG, the clinical outcome of patients with mesenteric ischemia has improved. ⋯ Patients with radiographic diagnosis of HPVG should receive a detailed history review and physical examination. The patient's underlying condition should be determined to provide a solid ground for exploratory laparotomy. A flow chart is presented for facilitating the management of patients with HPVG in the ED.