The American journal of emergency medicine
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Comparative Study
Normal amylase levels in the presentation of acute pancreatitis.
Recent literature suggests that serum amylase levels are not an appropriate screen for the diagnosis of acute pancreatitis because specificity and sensitivity are poor. Evidence from several studies supports the use of lipase determinations to diagnose acute pancreatitis, and recent improvements in this assay have made it more readily available to the emergency physician. This retrospective review compares the use of serum amylase to lipase levels in the diagnosis of acute pancreatitis in 52 patients who presented to the emergency department, with the hospital discharge diagnosis serving as the gold standard to which the assays were compared. Serum lipase was found to be more sensitive than serum amylase (95% vs 79%); serum amylase levels decreased to normal significantly faster than lipase levels.
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Train accidents involving motor vehicles and pedestrians can be devastating. Approximately 1,234 fatalities were recorded in the United States in 1989. The literature from the United States is sparse, prompting a 7-year review of 23 consecutive train accident victims. ⋯ Three (14%) patients died. Although alcohol use occurred in 16 (70%), there was no significance between alcohol use and amputation. Thus, non-railroad employed pedestrians, because of a lack of protection, are more prone to traumatic amputations, primarily of the lower extremities, than those involved in motor vehicle accidents.
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An unusual case of acute appendicitis induced by a metal drill bit that was ingested by a 27-year-old man 3 years before presentation is reported. This foreign body lodged in the patient's appendix and developed a fecalith coating. When this fecalith coating enlarged enough to obstruct the appendiceal lumen, the patient presented with classic acute appendicitis. Foreign body-induced appendicitis is reviewed.
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The hypothesis that the use of an observation unit (OU) in the emergency department (ED) results in monetary savings by lowering the hospital admission rate for asthma was studied in a retrospective comparative cohort at an urban university county hospital. All acute asthmatic patients seen in the ED during a 22-month period were included. Preobservation patients were seen before the OU opened (n = 834); postobservation patients were treated afterward (n = 390). ⋯ However, 5.3% less patients were admitted directly to the hospital (P = .01), and 6.7% less patients were discharged directly from the ED (P = .005). The OU produced no demonstrable cost savings. The use of an OU for asthmatic patients results in lower initial discharge rates from the ED and does not reduce eventual hospital admission appreciably.
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The authors' observation of an apparent increased incidence of patients presenting with spontaneous subarachnoid hemorrhage (SAH) during stormy weather prompted them to retrospectively review admissions data during an 18-month period to look for an association between SAH and changes in barometric pressure (BMP). Of the 39,049 cases examined, 76 had confirmed SAH. Continuous graphs of BMP were used to categorize days as being "flat" days (change in BMP < or = 0.15; dpHg) or "change" days (change in BMP > 0.15; dpHg). ⋯ The correlation of SAH with change in BMP did not hold if these summer months were examined alone. The risk ratio of having an SAH on an inclement day during the winter months was 1.99 (95% confidence interval, 1.11 to 3.60). The reason for this association is not clear at this time.