The American journal of emergency medicine
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In 1989, Champion et al recommended revising the Trauma Score to exclude capillary refill because it is "difficult to assess at night. . . ." However, a literature search produced no studies evaluating the effect of lighting conditions on the assessment of capillary refill. This study was undertaken to determine if any such effect exists. ⋯ In daylight conditions (partly cloudy day, lux meter = 15 to 16), capillary refill was reported as normal in 94.2% of the participants, delayed in 1.9% of the participants, and undetected in 3.9% of the participants. In dark conditions (moonlight or street lamp, lux meter = 4 to 6), capillary refill was reported as normal in 31.7% of the participants, delayed in 1.6% of the participants, and undetected in 66.7% of the participants. chi 2 analysis demonstrated a statistically significant difference between capillary refill assessment in light versus dark environments (P < .001).
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Because the benefits from thrombolytic therapy in acute myocardial infarction (AMI) are time dependent, multiple strategies have been devised to speed therapy. This study sought to determine whether hospital-based nurse and paramedic advanced life support (ALS) providers could be trained to independently evaluate (sight read) a prehospital 12-lead electrocardiogram (ECG) for the presence of AMI as part of a protocol designed to speed in-hospital administration of thrombolytic agents. Providers were required to determine on the basis of a protocol (1) whether or not AMI was present, and (2) whether or not thrombolytic therapy was indicated. ⋯ Fourteen patients (9%) received thrombolytic therapy. In-hospital times to administration of thrombolytic therapy decreased to an average of 22 +/- 13.8 minutes in the studied group compared with a historical control group average of 51 +/- 50 minutes. It is concluded that hospital-based paramedics and nurses can successfully be taught to evaluate (ie, sight read) a prehospital ECG for the presence of AMI with accuracy.(ABSTRACT TRUNCATED AT 250 WORDS)
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Ethanol intoxication has been widely reported as a cause of lactic acidosis. To determine the frequency and severity of ethanol-induced lactic acidosis, patients who presented to an emergency department with a clinical diagnosis of acute ethanol intoxication and a serum ethanol concentration of at least 100 mg/dL were studied. Arterial blood was sampled for lactate and blood gas determinations. ⋯ Only one case with elevated blood lactate concentration had associated acidemia. Significant elevations of blood lactate are uncommon in acute ethanol intoxication. In patients with ethanol intoxication who are found to have lactic acidosis, other etiologies for the elevated lactate level should be considered.
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Comparative Study
Normal amylase levels in the presentation of acute pancreatitis.
Recent literature suggests that serum amylase levels are not an appropriate screen for the diagnosis of acute pancreatitis because specificity and sensitivity are poor. Evidence from several studies supports the use of lipase determinations to diagnose acute pancreatitis, and recent improvements in this assay have made it more readily available to the emergency physician. This retrospective review compares the use of serum amylase to lipase levels in the diagnosis of acute pancreatitis in 52 patients who presented to the emergency department, with the hospital discharge diagnosis serving as the gold standard to which the assays were compared. Serum lipase was found to be more sensitive than serum amylase (95% vs 79%); serum amylase levels decreased to normal significantly faster than lipase levels.
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Previous literature has identified uvulitis as a condition with serious implications. This report details a series of 15 patients with uvulitis whose clinical features were remarkable for a relatively benign course. This is the largest series of patients with uvulitis in the literature. ⋯ Of the 14 patients discharged, 13 (93%) were followed-up and none required further care. Seven (50%) of the discharged patients received symptomatic treatment only, whereas the others were treated with medications including antibiotics, corticosteroids, diphenhydramine, and B-agonists. Further research into the etiology and management of uvulitis is warranted.