Annals of emergency medicine
-
To determine retrospectively the diagnostic accuracy of various ECG ST segment elevation criteria for the prehospital ECG diagnosis of acute myocardial infarction. ⋯ Fifty-one percent of patients whose prehospital 12-lead ECG met 1 mm or more ST segment elevation criteria had non-myocardial infarction diagnoses. ST segment elevation alone lacks the positive predictive value necessary for reliable prehospital myocardial infarction diagnosis. Inclusion of reciprocal changes in prehospital ECG myocardial infarction criteria improved the positive predictive value to more than 90% and included a significant majority (62% to 86%) of acute myocardial infarction patients with ST segment elevation who received thrombolytic therapy within five hours after hospital arrival. ST segment elevation criteria that include reciprocal changes identify patients who stand to benefit most from early interventional strategies.
-
Case Reports
Pneumocephalus following an epidural blood patch procedure: an unusual cause of severe headache.
Pneumocephalus is a rare complication of anesthetic procedures involving the epidural space. We report the case of a 36-year-old woman who developed a severe headache due to pneumocephalus that occurred during an epidural blood patching procedure. This report reviews the blood patch procedure and its attendant complications. Emergency physicians should be aware of the potential complications of this commonly performed procedure and include iatrogenic pneumocephalus in the differential diagnosis of severe headache in the proper clinical scenario.
-
To determine the effects of standard spinal immobilization on a group of healthy volunteers with respect to induced pain and discomfort. ⋯ Standard spinal immobilization may be a cause of pain in an otherwise healthy subject.
-
To evaluate a standardized training program in intraosseous (IO) infusion for prehospital providers. ⋯ A one-hour standardized training session was successfully used to train prehospital providers in the procedure of IO infusion. IO infusion then was implemented into their clinical practice with a satisfactory success rate and few complications.