The American journal of emergency medicine
-
This study examined consecutive patients with unexplained fever (UF) presenting to the ED to define their characteristics and to compare distinctive parameters between admitted and discharged patients. During a 3-month period, all adult patients presenting to the ED with UF were prospectively followed for 1 month. ⋯ The admitted patients were older, had more comorbidity, higher leukocyte count, and anemia, but not a higher degree of fever. Older age, comorbidity, leukocytosis, and anemia, but not higher degree of fever, should direct the decision toward admission of a patient with UF.
-
Comparative Study
The effect of practitioner characteristics on patient pain and embarrassment during ED internal examinations.
The objective was to determine if practitioner characteristics influence patients' pain and embarrassment during an emergency department (ED) internal pelvic examination (IPE). This prospective, comparative study was performed in an urban, university teaching hospital ED with an annual census of 64,000. The study population consisted of a convenience sample of patients who required an IPE as part of her ED evaluation. Information gathered included patient age and final diagnosis, as well as examiner gender and level of training (LOT). Immediately after IPE, the patient was asked to rate both pain and embarrassment of the examination using a previously validated 100-mm visual analog scale (VAS). Finally, each subject was asked to indicate her practitioner gender preference for IPE. The influence of examiner gender and LOT on patient pain and embarrassment was assessed using a t-test or ANOVA with significance defined as P <.05. A total of 278 subjects completed the study (mean age 27.7 +/- 10.5 years, range 13 to 70 years). The mean pain and embarrassment scores were 29.7 and 17.5 respectively. Examiner gender, examiner LOT and patient age did not predict pain and embarrassment scores. Overall, 173 (62%) patients had no practitioner gender preference, whereas 93 (34%) preferred women and 11 (4%) preferred men. ⋯ Examiner characteristics do not influence either the pain or the embarrassment associated with IPE in the ED.
-
Case Reports
Diphenhydramine-induced wide complex dysrhythmia responds to treatment with sodium bicarbonate.
Diphenhydramine, a common ingredient in over-the-counter medications, is often taken in overdose. Toxicity is usually limited to anticholinergic symptoms. ⋯ Although it would be expected that, like other type IA toxicities, diphenhydramine-induced cardiotoxicity could be responsive to hypertonic sodium bicarbonate, this finding is largely unappreciated. We describe 3 cases of diphenhydramine-induced cardiac toxicity that were responsive to bicarbonate.
-
It has been shown that thrombolytic therapy can improve clinical outcome in some patients with acute cerebral ischemia. These patients have been reported to be characterized by certain clinical and imaging findings, mainly with non-contrast enhanced computed tomography (CT). Our purpose in this study was to find out whether CT angiography (CTA) information about the status of the cerebral vessels is helpful in the selection of patients who may benefit the most from thrombolytic therapy for acvte cerebral ischemia. ⋯ CTA can provide important information before the initiation of thrombolytic therapy. Identification both of the occluded vessel and of an intracranial aneurysm is feasible with the use of CTA, which is particularly important if the intracranial aneurysm is a potential contraindication to thrombolytic therapy. Occlusion of a secondary branch of the MCA and internal carotid artery occlusion are valuable prognostic predictors.
-
Case Reports
Diffusion-weighted MRI of intracerebral hemorrhage clinically undifferentiated from ischemic stroke.
This report describes diffusion-weighted MRI findings of some intracerebral hemorrhages clinically undifferentiated from ischemic stroke. We treated patients with characteristic features of intracerebral hemorrhages that could distinguish themselves from ischemic lesion on diffusion-weighted imaging. Therefore, we think diffusion-weighted imaging could be an emergency screening tool for ischemic stroke as an alternative to computed tomography, and the EP should be familiar with the diffusion-weighted imaging findings of intracerebral hemorrhage as well as cerebral infarction.