The American journal of emergency medicine
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Clinicians may not perform a medical-legal examination in cases in which a sexual assault was attempted but no penile-vaginal contact occurred. This retrospective study was conducted to document the frequency and type of genital injuries in women in whom forced digital penetration was the only reported type of assault. Study patients were consecutive female patients presenting to an urban sexual assault clinic during a 3-year study period. ⋯ Fifty-six percent of the injuries occurred at four sites: fossa navicularis, labia minora, cervix, and posterior fourchette. The most common type of injury was erythema (34%) followed by superficial tears (29%) and abrasions (21%). Colposcopy with nuclear staining was useful in detecting these injuries--and can provide valuable legal information in sexual assault victims reporting only digital-vaginal penetration.
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Plasma ammonia measurement is a simple yet important screening in the ED for patients with unexplained stupor or delirium. Acute hyperammonemia is a medical emergency for which immediate steps must be taken to minimize permanent brain damage. Although the most common causes of hyperammonemia are severe abnormal liver function, the absence of liver disease in some cases has been observed. ⋯ Once a specific diagnosis was reached, protein restriction, essential amino acid supplementation, efficient chemotherapy, and valproic acid and 5-FU level discontinuance were instituted. In this report, the clinical presentation, pathogenesis, and diagnostic workup for various hyperammonemia causes are discussed. Every EP should understand that the clinical symptoms for hyperammonemia and prognosis are related to early diagnosis.
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Many rapid d-dimer assays are commercially available with wide ranges of reported sensitivities, often based on small sample sizes. This has limited their intended use as rapid and inexpensive tests to evaluate pulmonary embolism in the low-risk patient. We sought to determine the sensitivity of the STA-Liatest D-Di d-dimer assay in our ED. ⋯ Using the exact method, the sensitivity of this assay was calculated to be 100% with a 95% confidence interval (CI) of 91.4% to 100%. Our results suggest that the STA-Liatest D-Di d-dimer assay could have an adequate sensitivity to be used to rule out pulmonary embolism in low-risk patients. Further prospective studies with larger sample sizes are required to validate this observation.
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Evaluation of the electrocardiogram (ECG) is a complex, subjective process with the potential for interobserver disagreement. The objective of this study was to determine the ECG patterns with discrepant interpretations, the rates of disagreement in the determination of both the presence of ST segment elevation (STE) and morphology. ECGs were reviewed in a retrospective fashion by attending EPs for STE and waveform morphology. ⋯ Fourteen ECGs (8.2% of 171 ECGs with STE determined by at least 2 EPs) had ST segment morphology interpreted in a discrepant fashion. Disagreement in the determination of electrocardiographic ST segment elevation by EPs occurs frequently and is related to the amount of STE present on the ECG. Electrocardiographic patterns responsible for this interpretive disagreement of ST segment elevation can represent an unfortunate but potentially predictable source of error in emergency medical care.