J Emerg Med
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The COVID-19 pandemic presents a significant challenge to the global health care system. Implementing timely, accurate, and cost-effective screening approaches is crucial in preventing infections and saving lives by guiding disease management. ⋯ This study developed and validated three machine learning prediction models for COVID-19 mortality based on accessible clinical features. The RF model showed the best performance among the three models. The nine variables identified in the models may warrant further investigation as potential prognostic indicators of severe COVID-19.
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The U.S. Medical Licensing Examination (USMLE) Step 1 has been used as a screening tool for residency selection. In February 2020, Step 1 numerical scoring changed to pass/fail. ⋯ Most EM programs disagree with pass/fail scoring of Step 1 and will most likely use Step 2 score as a screening tool. The cSLOEs, EM rotation grades, and interview are considered the most important selection factors.
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Biatrial thrombus is a rare condition that is typically associated with a patent foramen ovale (PFO). ⋯ This is a case of a 75-year-old man with history of heavy alcohol use found down with altered sensorium. He was hypothermic and in atrial fibrillation with rapid ventricular rate and was subsequently found to have a biatrial thrombus with no evidence of PFO. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Biatrial thrombus presents the unique danger of progressing to both pulmonary embolus and acute embolic disease (including stroke); both are life-threatening diagnoses that can be prevented by means of identifying and treating this rare and dangerous condition.
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Reducing the time between onset of cerebral infarction and treatment with tissue plasminogen activator improves the prognosis of patients with cerebral infarction. Diverse dosing protocols have been developed with the aim of reducing the time to bolus injection; however, only a few studies have investigated the methods and effects of the interrupted time between bolus and post-bolus infusion. ⋯ Because of the short half-life of alteplase, even a short delay in initiating post-bolus infusion can cause a significant reduction in serum alteplase concentration.