The American journal of emergency medicine
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To determine the clinical usefulness of infrared skin temperatures in diagnosing appendicitis, the authors conducted a prospective study of 86 adult and pediatric emergency department (ED) patients presenting during a 4-month study period with acute right lower abdominal pain. Skin temperature readings (FirstTemp digital thermometer, Intelligent Medical Systems, Inc, Carlsbad, CA) were taken from the right lower abdominal quadrant and a corresponding position on the left. An unpaired t test was used to determine if there was a significant difference between the right and left lower quadrants in patients with appendicitis. ⋯ There was no significant skin temperature differential between the lower abdominal quadrants in either patient group (0.0 degree C vs 0.1 degree C; P > .5). Three patients had a skin temperature on the right that was at least 1 degrees C warmer than on the left; none of these patients had appendicitis. The results suggest that infrared thermography is not a sensitive diagnostic test for acute appendicitis in the ED population.
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To evaluate the recently published Utstein algorithm (Ann Emerg Med 1991;20:861), the authors conducted a retrospective review of all advanced life support (ALS) trip sheets and hospital records of patients with prehospital cardiac arrests between January 1988 and December 1989. Telephone follow-up was used to determine 1-year survival rates. Of 713 arrests in the 24-month study period, 601 were of presumed cardiac etiology. ⋯ The Utstein style was found to be a useful algorithmic format for reporting prehospital cardiac arrest data in a manner that should allow direct comparison between emergency medical service (EMS) systems. Existing prehospital record-keeping practices (trip sheets) are easily adapted to this style of data collection, although certain data for the template (eg, resuscitations not attempted and alive at 1-year) are more difficult to ascertain. Additionally, the authors report their own experience during a 2-year period, including data that suggest that the majority of patients with cardiac arrest who survive to hospital discharge are still alive at 1 year.
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Ovarian vein thrombosis is a rare occurrence in the postpartum period. Two cases of postpartum ovarian vein thrombosis are presented. ⋯ Early diagnosis is essential for appropriate treatment and prevention of the potential sequelae that can occur. Computerized tomography with contrast is the optimal imaging modality for the diagnosis.
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A case of atypical or complicated migraine is presented with signs and symptoms of meningeal irritation, projectile emesis NS obtundation, and unresponsiveness. The patient is a 19-year-old diabetic on insulin who had a mild episode of upper respiratory tract symptoms with severe headache and was found unresponsive and brought to the emergency department. After a work-up for meningitis was negative (as well as computerized tomography and magnetic resonance imaging) he recovered totally in 3 days with no residual signs or symptoms and was discharged from the hospital.
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Little data exist concerning the actual onset time (time zero) in sudden death (SD) and acute myocardial infarction (AMI). Most studies have focused on describing the warning arrhythmias that occur before SD and AMI and have relied on retrospective analyses of fortuitous data obtained from patients who experience these adverse outcomes while undergoing routine ambulatory holter monitoring. ⋯ Analyses of the serial 12-lead electrocardiographs showed extensive transient silent ST-segment elevations and depressions preceding cardiac arrest and AMI and provided insight in the pathogenesis of SD and AMI. Continuous 12-lead ECG monitoring can identify patients at high risk for SD and AMI and allow physicians to intervene before the development of life-threatening conditions.