Annals of emergency medicine
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Community-acquired infections and non-AIDS-related illnesses are a significant proportion of the final diagnoses in HIV-infected patients presenting to an emergency department. We hypothesized that emergency physicians over-diagnose opportunistic infections in the HIV-infected patient. We also hypothesized that the absolute CD4 lymphocyte level could be used to stratify patients by likelihood of HIV related disease. ⋯ ED visits by HIV-infected individuals are often not made for reasons of opportunistic infection, and the absolute CD4 lymphocyte count is inversely related to HIV-related disease.
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Randomized Controlled Trial Comparative Study Clinical Trial
Effectiveness of verapamil-quinidine versus digoxin-quinidine in the emergency department treatment of paroxysmal atrial fibrillation.
To determine the relative effectiveness of a verapamil-quinidine sequential combination versus digoxin-quinidine in the emergency department treatment of paroxysmal atrial fibrillation (PAF). ⋯ The sequential combination of verapamil and quinidine, in the doses studied, is an effective treatment for PAF and is superior to digoxin-quinidine. Digoxin should no longer be considered the treatment of choice for uncomplicated PAF.
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Randomized Controlled Trial Comparative Study Clinical Trial
Emergency management of atrial fibrillation and flutter: intravenous diltiazem versus intravenous digoxin.
To compare the effects of i.v. diltiazem and i.v. digoxin on ventricular rate control in the emergency treatment of acute atrial fibrillation and flutter (AFF). ⋯ Treatment of acute AFF with i.v. diltiazem decreases ventricular heart rate significantly within 5 minutes, compared with 3 hours for treatment with i.v. digoxin. No advantage was noted within 3 hours for i.v. treatment with a combination of diltiazem and digoxin. I.v. diltiazem is superior to i.v. digoxin in the emergency control of ventricular rate in acute AFF and should be considered as a drug of choice for this condition. This study was not large enough to adequately assess adverse effects, and further studies may be warranted for clinical validation.
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Comparative Study
Feasibility of a rapid diagnostic protocol for an emergency department chest pain unit.
To evaluate the applicability of a short-stay protocol for exclusion of acute ischemic heart disease without hospital admission and to analyze these results in the context of a conceptual model. ⋯ Although most admitted patients with chest pain (53%) were at low probability for AMI, only a minority (14%) were eligible for a short-stay protocol that required patients to be free of known coronary artery disease and able to perform an exercise tolerance test. Factors affecting the operations and efficiency of a CPOU include clinical characteristics of the target patient population, protocol tests used, and hospital occupancy and reimbursement patterns.