J Emerg Med
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Capnography has many uses in the emergency department (ED) and critical care setting, most commonly cardiac arrest and procedural sedation. ⋯ Capnography demonstrates benefit in cardiac arrest, procedural sedation, mechanically ventilated patients, and patients with metabolic acidemia. Further study is required in patients with seizure, trauma, and respiratory conditions. It should only be used in conjunction with other patient factors and clinical assessment.
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Case Reports
Iodinated Contrast Administration Resulting in Cardiogenic Shock in Patient with Uncontrolled Graves Disease.
Thyroid storm (also known as thyroid or thyrotoxic crisis) is part of the spectrum of thyrotoxicosis and represents the extreme end of that spectrum. The condition is quite rare, yet mortality rates are high and may approach 10-30%. ⋯ A 34-year-old-man who had a history of Graves disease presented in atrial fibrillation with rapid ventricular response and mild congestive heart failure. During the course of his Emergency Department (ED) stay he deteriorated into cardiogenic shock. Roughly 10 h transpired between his presentation and the development of cardiogenic shock. He had received an intravenous contrast load of iohexol shortly after initial presentation, and the associated iodine bolus, we suspect, contributed to his abrupt deterioration into cardiogenic shock. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Thyroid storm is infrequently seen in the ED, and there is potential for management errors that can lead to a detrimental patient outcome.
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Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) are common sexually transmitted infections seen in the emergency department (ED). Due to an inability to reliably make accurate diagnosis by physical examination, concern for unreliable follow-up, and current delays in diagnostic nucleic acid amplification testing (NAAT), presumptive treatment active against CT and NG, as described by Centers for Disease Control clinical practice guidelines, is often performed. ⋯ Although the rapid Xpert CT/NG assay's diagnostic sensitivity did not meet our prespecified threshold for noninferiority, the diagnostic characteristics are robust enough to fit into a management pathway that may reduce unnecessary antibiotic use. There may be an opportunity to utilize the rapid Xpert CT/NG assay to improve accuracy of treatment in the ED.