J Emerg Med
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Spinal epidural abscess is an uncommon disease with a relatively high rate of associated morbidity and mortality. The most important determinant of outcome is early diagnosis and initiation of appropriate treatment. ⋯ Patients with a spinal epidural abscess often present first in the emergency department setting. It is imperative for the emergency physician to be familiar with the clinical features, diagnostic work-up, and basic management principles of spinal epidural abscess.
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Prior studies have suggested gender-based differences in the care of elderly patients with acute medical conditions such as myocardial infarction and stroke, but it is unknown whether these differences are seen in the care of abdominal pain. The objective of this study was to examine differences in evaluation, management, and diagnoses between elderly men and women presenting to the Emergency Department (ED) with abdominal pain. For this observational cohort study, a chart review was conducted of consecutive patients aged 70 years or older presenting with a chief complaint of abdominal pain. ⋯ Men had a higher rate of death within 3 months of the visit (19% vs. 1%, respectively, p < 0.001). Unlike prior research in younger patients with abdominal pain and among elders with other acute conditions, we noted no difference in management and diagnoses between older men and women who presented with abdominal pain. Despite a similar predicted mortality and ED evaluation, men had a higher rate of death within 3 months.
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Case Reports
Repeat Wellens' syndrome: case report of critical proximal left anterior descending artery restenosis.
We describe the case of a 40-year-old woman who presented to the Emergency Department with resolving chest pain. The initial electrocardiogram (ECG) showed biphasic T-waves in V2-V4, which was recognized as Wellens' syndrome, or acute coronary T-wave syndrome. Emergent cardiac catheterization revealed 95% stenosis of the previously placed stent in the proximal left anterior descending artery (LAD). ⋯ We report this case to increase awareness of the T-wave abnormalities associated with Wellens' syndrome. There is significant morbidity and mortality that can occur in the absence of emergent coronary revascularization. This report of repeated Wellens' syndrome in the same patient demonstrates both types of precordial T-wave abnormalities that characterize Wellens' syndrome.
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The utility of ultrasound-guided peripheral intravenous access (USGPIV) has been well described. However, few studies have investigated USGPIV techniques. ⋯ Modified Seldinger technique is an effective method of USGPIV and is worthy of a prospective comparison with non-Seldinger technique.