Annals of emergency medicine
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Comparative Study Clinical Trial
Serum progesterone testing to predict ectopic pregnancy in symptomatic first-trimester patients.
This study was conducted to prospectively measure the accuracy of serum progesterone levels to detect ectopic pregnancy. ⋯ Given similar disease prevalence, roughly one fourth (178/716) of symptomatic patients can be classified as low risk (0%, 95% confidence interval 0 to 2%) for having an ectopic pregnancy using a progesterone cutoff of 22 ng/mL. Whether implementation of rapid progesterone testing can safely expedite care and reduce the need for urgent diagnostic evaluation or admission remains to be determined.
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We report the case of a 49-year-old man in whom a diagnosis of Brugada syndrome was made after he presented to the emergency department for evaluation of a syncopal episode. The diagnosis was made by ECG changes, after the characteristic findings of peculiar downsloping ST-segment elevation in leads V(1) and V(2) and QRS morphology resembling a right bundle branch block were identified. Emergency physician recognition of this syndrome and its ECG findings is essential, because without treatment the incidence of sudden cardiac death in these patients is high.
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Sulfonylurea agents are widely used as therapy for hyperglycemia in type 2 diabetes mellitus. In overdose, these agents can produce sustained and profound hypoglycemia that is refractory to treatment with dextrose alone. Our objective was to determine whether treatment with octreotide decreases glucose requirements and the number of hypoglycemic episodes in patients with sulfonylurea-induced hypoglycemia. ⋯ Octreotide appears to be safe and effective in preventing rebound hypoglycemia after sulfonylurea ingestion. Octreotide in combination with dextrose should be considered for first-line therapy in the treatment of sulfonylurea-induced hypoglycemia.