J Emerg Med
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Randomized Controlled Trial
Emergency provider attitudes and barriers to universal HIV testing in the emergency department.
The Centers for Disease Control and Prevention (CDC) recently published recommendations for routine, voluntary human immunodeficiency virus (HIV) testing of adults in all health care settings, including the emergency department (ED). ⋯ After the implementation of a large-scale HIV testing program in an ED, the majority of emergency providers were supportive of routine HIV testing. Nevertheless, 6 months after program initiation, providers were still reluctant to offer the test due to persistent barriers. Further studies are needed to identify feasible implementation strategies that minimize barriers to routine HIV testing in the ED.
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Thyroid storm is an often-discussed but rare presentation to emergency departments (EDs). The clinical presentation of a thyroid storm is the result of a hyperthyroid state that may result in significant morbidity or disability, or even death. Typically, patients are aware of their hyperthyroid condition, and may be able to recognize an episode of thyroid storm. However, the first presentation of hyperthyroidism could, in fact, be from thyrotoxic crisis. ⋯ We use this case to emphasize that thyrotoxic crisis should be at least considered in the differential diagnosis of a patient with this presentation, and to highlight how, even with apparently usual and effective treatments, a patient may still decompensate.
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Review Case Reports
Hypercapnic coma due to spontaneous pneumothorax: case report and review of the literature.
Hypercapnic coma is a rare differential diagnosis in the unconscious patient. One underlying mechanism may be hypoventilation due to spontaneous pneumothorax. Although hypercapnia is not a typical finding in spontaneous pneumothorax in patients with otherwise healthy lungs, under certain circumstances, hypercapnia may readily develop. ⋯ Although severe hypercapnia is usually due to decompensation of chronic lung disease, pneumothorax potentially may cause hypercapnic coma. Review of the literature suggests that there is no close correlation between arterial pCO(2) (partial pressure of CO(2)) levels and the degree of impairment of consciousness; however, levels exceeding 80 mm Hg are likely associated with significantly impaired consciousness. Hypercapnic coma usually resolves without neurological deficit as arterial pCO(2) tensions decline.
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Randomized Controlled Trial
Rescuer fatigue in the elderly: standard vs. hands-only CPR.
Hands-only cardiopulmonary resuscitation (HO-CPR) is recommended as an alternative to standard CPR (STD-CPR). Studies have shown a degradation of adequate compressions with HO-CPR after 2 min when performed by young, healthy medical students. Elderly rescuers' ability to maintain an adequate compression rate and depth until emergency medical services (EMS) arrives is unknown. ⋯ Although HO-CPR resulted in a greater number of overall compressions than STD-CPR, STD-CPR resulted in a greater number of adequate compressions in all but the first minute of resuscitation.
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Pulmonary embolism (PE), an uncommon diagnosis in pediatric patients, is a potentially life-threatening condition with significant morbidity and mortality. Improvements in pediatric care have resulted in survival of more chronically and critically ill children and thus, an increased number of pediatric patients at risk for this disease. ⋯ Although there is a significant lack of pediatric-specific literature pertaining to the diagnosis and management of PE, there are clear differences in the emergency approach to these patients, including specific risk factors and the inutility of clinical decision rules and D-dimer. CONCLUSION/SUMMARY: We outline these differences and present rational diagnostic and treatment algorithms.