Annals of emergency medicine
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Historical Article
The many faces of MRSA: community-acquired infection knows no bounds.
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Routine ECG testing is recommended in the evaluation of syncope, although the value of such testing in young patients is unclear. For ECG testing, we assess the diagnostic yield (frequency that ECG identified the reason for syncope) and predictive accuracy for 14-day cardiac events after an episode of syncope as a function of age. ⋯ ECG testing in patients younger than 40 years did not reveal a cardiac cause of syncope and was associated with a significant frequency of abnormal ECG findings unrelated to syncope. Although our findings should be verified in larger studies, it may be reasonable to defer ECG testing in younger patients who have a presentation consistent with a benign cause of syncope.
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It is now clear that transient ischemic attacks and strokes are different manifestations of the same disease and transient ischemic attacks are often warning signs of an impending stroke. Unfortunately, it is unclear when the next event will occur in an individual patient. It is critical for emergency physicians to know what the true risk of stroke is for patients who present to the emergency department (ED) with a transient ischemic attack and a normal neurologic examination result. We perform an evidence-based emergency medicine shortcut review of the short-term outcome of stroke among patients diagnosed in the ED with a transient ischemic attack. ⋯ According to studies assessing the short-term prognosis of patients diagnosed with transient ischemic attack in the ED, approximately 1 in 20 patients will have a stroke during the following 48 hours.
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WHAT IS ALREADY KNOWN ON THIS TOPIC: The Centers for Disease Control and Prevention recommends that HIV screening be incorporated into routine care unless patients opt out, but most emergency departments (EDs) have not adopted routine screening. WHAT QUESTION THIS STUDY ADDRESSED: Will patients accept routine HIV testing in the ED without separate written consent or traditional pre- and posttest counseling? WHAT THIS STUDY ADDS TO OUR KNOWLEDGE: In this survey, 81% were willing to receive free HIV testing in the ED, but many required explanation of opt-out testing. ⋯ Nevertheless, screening is unlikely to be adopted in busy EDs unless payment and workload issues can be resolved. The yield of routine ED screening may be low in most settings.