J Emerg Med
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Stress-only myocardial perfusion imaging (MPI) saves time by eliminating rest imaging, which is important for emergency department (ED) throughput but has not been studied in an ED population. ⋯ A normal stress-only MPI study has a benign 1-year prognosis similar to a rest-stress study when performed in the ED. The ability to triage patients more rapidly and reduce radiation exposure represents an attractive alternative for low-risk patients.
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Case Reports
Ecstasy-associated acute severe hyponatremia and cerebral edema: a role for osmotic diuresis?
Ecstasy, or 3,4-methylenedioxymethamphetamine (MDMA), is a drug of abuse with a wide range of toxicity affecting the brain, heart, and liver. Renal toxicity of MDMA is due either to acute kidney injury (e.g., non-traumatic rhabdomyolysis) or to water and electrolyte imbalance (i.e., hyponatremia). Although syndrome of inappropriate secretion of antidiuretic hormone has been recognized as a major mechanism for MDMA-associated hyponatremia, other factors (e.g., MDMA-induced polydipsia) have also been proposed. ⋯ Based on this observation, coupled with the previous report and the complex pathophysiology of this phenomenon, we suggest that osmotic diuresis be considered a possible therapeutic option for MDMA-associated acute symptomatic hyponatremia.
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Point-of-care tests for toxicological screening of patients for drugs of abuse and therapeutic drugs may be helpful in the emergency department (ED) to assist in a rapid diagnosis. ⋯ In the ED setting, the Triage TOX Drug Screen performed better than the other point-of-care tests, probably due to its more objective reading system and its adequate quality controls.
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Hyperleukocytosis in acute leukemia is associated with lymphadenopathy, hepatosplenomegaly, disseminated intravascular coagulation, and central nervous system complications. Patients with hyperleukocytosis have lower complete remission rates and have a higher mortality rate, primarily from intracranial hemorrhage. ⋯ Patients with acute leukemia may present with hyperleukocytosis, which may result in decreased tissue perfusion. Ischemia occurring in the heart can lead to an acute myocardial infarction, whereas ischemia in the brain can lead to a stroke. These events may, on occasion, be the initial presentation of leukemia. Rapid identification and treatment of the hyperleukocytosis may prevent these complications.
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Acute superior mesenteric artery (SMA) occlusion leads to acute intestinal ischemia and is associated with high mortality. Early diagnosis is often missed, and confounding factors leading to diagnostic delays need to be highlighted. ⋯ Elevated TnI was common in acute SMA occlusion, and referral to the cardiologist was found to be associated with adverse outcome. Elevated pancreas amylase and normal plasma lactate values are also potential pitfalls at admission in patients with acute SMA occlusion.