J Emerg Med
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Syncope is a common presentation to the Emergency Department (ED); however, appropriate management and indications for hospitalization remain an ongoing challenge. The objective of this study was to determine if a predefined decision rule could accurately identify patients with syncope likely to have an adverse outcome or critical intervention. A prospective, observational, cohort study was conducted of consecutive ED patients aged 18 years or older presenting with syncope. ⋯ The rule identified 66/68 patients who met the outcome for a sensitivity of 97% (95% confidence interval 93-100%) and specificity of 62% (56-69%). This pathway may be useful in identifying patients with syncope who are likely to have adverse outcome or critical interventions. Implementation and multicenter validation is needed before widespread application.
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Case Reports
Spontaneous spinal epidural hematoma causing Brown-Sequard syndrome: case report and review of the literature.
Spinal epidural hematoma is a rare clinical entity and has a varied etiology. Urgent surgical evacuation to prevent serious permanent neurologic deficits is generally indicated. ⋯ This diagnosis was initially overlooked, given the asymmetric pattern of deficit. He later underwent cervical laminectomy and had complete restoration of neurologic function.
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The purpose of this study was to examine whether the SAGE assessment survey could predict, within the Emergency Department setting, those youth at risk for engaging in violent behavior. It also examined whether those who test positive for engaging in high-risk violent behavior during the initial baseline SAGE survey were prone to continue this behavior 1 month later. This was an observation, convenience sample of young male and female patients, half of whom had injuries related to violence and half of whom had injuries unrelated to violence, who presented when a research fellow was available. ⋯ A set of four questions from the 12-question SAGE survey, however, was successful at tracking specific types of at-risk behaviors. This indicates that certain questions within the SAGE survey may be effective at tracking those who engage in high-risk violent behavior. These same questions were able to track those who continued to engage in high-risk violent behaviors 1 month later.
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Multicenter Study
Association between a positive ED FAST examination and therapeutic laparotomy in normotensive blunt trauma patients.
Although a positive FAST (focused assessment with sonography for trauma) examination in hypotensive blunt trauma patients generally suggests the need for emergent laparotomy, this finding's significance in normotensive trauma patients is unclear. We tested the association between a positive FAST and the need for therapeutic laparotomy in normotensive blunt trauma patients. This was a retrospective cohort analysis of consecutive normotensive blunt trauma patients presenting to two trauma centers. ⋯ Thirty-seven percent of patients with a positive FAST required therapeutic laparotomy vs. 0.5% with a negative FAST. Among normotensive blunt trauma patients, there was a strong association between a positive FAST and the need for therapeutic laparotomy. Very few normotensive patients with a negative FAST required therapeutic laparotomy.
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Living wills are thought to protect the medical decision-making capacity of patients. Presented are three case scenarios of patients with living wills presenting to health care facilities for treatment, and their hospital courses. ⋯ This case series will define a scenario as well as how that scenario was affected by the presence of a living will. In addition, existing data regarding the care provided to patients with a code status designation of DNR (do not resuscitate) are reviewed.