Emergency medicine journal : EMJ
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Clinical introductionA 68-year-old man, with known spasticity and a total left hip arthroplasty (THA) performed 6 years ago, was brought to our ED after falling down the stairs. Laying on the stretcher, his left leg was internally rotated and in hyperflexion. An X-ray of the left hip was performed. ⋯ A dual-mobility cup is used and the liner is not in place anymore. Revision surgery is required. For answer see page 2.
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Case presentationA 57-year-old man was in a healthy state until 6 hours before presenting to the emergency department, when he suffered from more than 10 episodes of vomiting after a large meal at lunchtime. On physical examination, vital signs were unremarkable. ⋯ DC1SP110.1136/emermed-2019-208863.supp1Supplementary video emermed;37/1/41/F1F1F1Figure 1Transverse (A) and longitudinal (B) ultrasonography of the epigastrium. QUESTION: What is the most likely diagnosis?Hypertrophic pylorus stenosisAortic dissectionSuperior mesentery artery (SMA) syndromeVolvulus For answer see page 2.
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Multicenter Study Comparative Study
Comparison of four decision aids for the early diagnosis of acute coronary syndromes in the emergency department.
To directly compare the diagnostic accuracy of four decision aids (Troponin-only Manchester Acute Coronary Syndromes (T-MACS), History, ECG, Age, Risk factors and Troponin (HEART), Thrombolysis in Myocardial Infarction (TIMI) and Emergency Department Assessment of Chest Pain (EDACS)) used to expedite the early diagnosis of acute coronary syndromes (ACS) in the ED. ⋯ In this study, T-MACS could rule out AMI in 46.5% patients with 99.2% sensitivity. EDACS could rule out AMI in 48.3% patients with lower sensitivity, although the difference was not statistically significant. The HEART and TIMI scores had lower diagnostic accuracy.