The American journal of emergency medicine
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Letter Case Reports
Nitrous oxide "whippit" abuse presenting as clinical B12 deficiency and ataxia.
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Letter Case Reports
Descending necrotizing mediastinitis from upper respiratory infection.
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Letter Case Reports
Rate-related bundle branch block: an uncommon wide complex tachycardia.
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A large amount of EM information can be found on the Internet, but the accuracy of this information has not been determined. This study compares the "gold standards" of EM information on four common emergencies with top healthcare web sites. The study also examines the relationship of web sites' credentials and certification on content. ⋯ Despite recent efforts to improve web site content through certification, few web sites contained a significant amount of EM information on all four topics investigated. In fact, some of the information provided on these health information web sites has the potential to be dangerous. Thus, most web sites are not good sources of reference for the public to find out what to do in the case of a medical emergency.
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It is not exactly known how ED physicians perform in evaluating cardiac systolic murmurs. In 203 consecutive medical ED patients with systolic murmur, we compared the initial clinical evaluation, including auscultation, with transthoracic echocardiography. Of the 203 patients, 132 (65%) had innocent murmurs and 71 patients (35%) had valvular heart disease. ⋯ Independent significant positive predictors of valvular heart disease were grade >2/6 systolic murmur (odds ratio [OR], 8.3; confidence interval [CI], 3.5-19.7, P<.001) and pathologic electrocardiogram (ECG) (OR, 8.4; CI, 3.2-22, P<.001. Patients younger than 50 years with a systolic murmur graded < or =2/6 had innocent murmurs in 98%. The initial clinical evaluation, including auscultation, by experienced ED physicians in internal medicine distinguishes well between innocent murmurs and valvular heart disease in medical patients with cardiac systolic murmurs.