J Emerg Med
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Review Meta Analysis
Serum D-dimer is a sensitive test for the detection of acute aortic dissection: a pooled meta-analysis.
Acute aortic dissection is a rare but devastating condition with high mortality. Unfortunately, there is no sensitive screening indicator of disease in common use. The objective of this study was to assess the sensitivity and utility of the serum D-dimer as a test for acute aortic dissection. ⋯ The sensitivity of the D-dimer test was 327/349, 94% (95% confidence interval 91-96), and the point estimate was essentially unchanged in a sensitivity analysis, 183/192, 95% (95% confidence interval 91-98). Specificity ranged from 40% to 100%. Serum D-dimer is sensitive for acute aortic dissection and potentially represents a useful test for patients who present with a low likelihood of this disease.
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As carbon monoxide (CO) toxicity may present with non-specific signs and symptoms and without history of exposure, screening for CO toxicity may identify occult cases. The objective of this study was to determine whether non-invasive screening for CO exposure could be performed in all patients presenting to a high-volume urban emergency department (ED) and would identify patients with unsuspected CO toxicity. A study of adult patients, who presented to the ED for any complaint, prospectively screened for carboxyhemoglobin concentration by a pulse CO-oximeter (SpCO). ⋯ The mean SpCO was 5.17% +/- 3.78% among smokers and 2.90% +/- 2.76% among non-smokers. During the study period, 11 patients with presenting signs and symptoms not consistent with CO toxicity were identified through SpCO screening. Screening for CO toxicity using a non-invasive pulse CO-oximeter can be conducted even in a busy tertiary center ED and identify patients with occult CO toxicity.
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As many as 300,000 transient ischemic attacks (TIAs) occur in the United States each year, accounting for 0.3% of all Emergency Department visits. An under-recognized and under-treated problem, TIA is associated with up to a 10% risk of subsequent stroke within 7 days and a 25% risk of death at 1 year. ⋯ However, nearly 50% of patients with TIA leave the Emergency Department without any medication. This article discusses recent results from major antiplatelet clinical trials in stroke prevention and highlights the need for appropriate and timely initiation of antiplatelet treatment in patients with TIA.
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The Spaso technique consists of forward flexion, external rotation, and gentle traction for the reduction of anterior shoulder dislocations with the patient in the supine position. The aim of this prospective study was to assess clinical efficacy of the Spaso technique and to evaluate its complications. We prospectively evaluated 52 shoulder dislocations using the Spaso technique. ⋯ There were no complications associated with using the Spaso technique in this series. Patients with concomitant greater tuberosity fractures and late presentation had a lower success rate, although this was not statistically significant. The Spaso method is effective in reducing anterior shoulder dislocations without anesthesia or assistance and may decrease reduction time and length of stay in the Emergency Department.
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Patients who dislocate their mandible often present to the Emergency Department for care. Dislocation can occur after a variety of activities that hyperextend the mandible or open the mouth widely, such as yawning, laughing, or taking a large bite. Anterior dislocation is the most common type, in which the condylar head of the mandible dislocates out of the glenoid fossa anterior to the articular eminence of the temporal bone. ⋯ The emergency physician can often reduce the anterior mandibular dislocation with or without procedural sedation or local anesthesia. A variety of methods are available for closed reduction, including the classic approach and various alternatives such as the recumbent, posterior, and ipsilateral approaches, as well as the wrist pivot method, alternative manual technique, and gag reflex induction. This article will review the pathophysiology and clinical presentation of acute mandibular dislocations, as well as discuss the various closed reduction methods available for the practitioner.