The American journal of emergency medicine
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Case Reports
Iatrogenic STEMI in a male trauma patient due to coronary artery compression by a left sided chest tube.
Iatrogenic ST segment elevation myocardial infarction (STEMI) after insertion of a left sided thoracic tube is a rare insertional complication. We present a case of coronary artery compression of the left anterior descending artery (LAD) caused by a left sided chest tube placed after blunt thoracic trauma with pneumothorax resulting in a STEMI. A 53-year-old male patient with severe blunt thoracic trauma presented in the emergency department. ⋯ Complications after chest tube insertion can occur in up to 30 % of patients. However, no similar case with iatrogenic ST segment elevation myocardial infarction due to compression of a coronary artery has been reported in the literature so far. Knowledge of the possible complications of an intervention is important and a 'high level of suspicion' is required in order to recognize and resolve them quickly.
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Patient-reported penicillin allergies are frequently encountered in the emergency department (ED), which often lead to non-beta-lactam antibiotic use despite beta-lactams' place as first-line therapy in most bacterial infections. The PEN-FAST clinical decision tool was developed and validated to identify patients with a low risk of true penicillin allergies that do not require formal skin testing for rechallenging. The tool consists of four questions that add up to a total score ranging from 0 to 5. Scores of 0-2 are associated with low risk of true penicillin allergy (<5% risk of true reaction); scores of 3 with moderate risk (<20% risk); and scores of 4-5 with high risk (50% risk). The purpose of our study was to determine the safety and efficacy of our facility's implementation of pharmacist utilization of the PEN-FAST screening tool to assess purported penicillin allergies and rechallenge low to moderate risk patients in the ED. ⋯ In this prospective, observational study, administration of beta-lactam antibiotics to ED patients with previously reported penicillin allergies and a PEN-FAST score less than 3 did not result in any immune-mediated reactions. The PEN-FAST decision tool was able to safely identify and risk-stratify eligible patients for beta-lactam rechallenge in the ED.