The American journal of emergency medicine
-
Multicenter Study Comparative Study
Preferences for cardiac tests and procedures may partially explain sex but not race disparities.
There are known race and sex differences in emergent cardiac care. Many feel these differences reflect a bias from the physician. We hypothesized these differences may be the result of patient preferences. ⋯ Blacks were more likely to prefer the less invasive stress test and wanted PCIs more, but these racial differences disappeared when a physician-recommended test was offered. Women were more likely to refuse the most invasive cardiac procedure compared with men. The sex-related preferences might partially explain why women receive fewer invasive cardiac procedures than men. However, race-related cardiac preferences suggest that other factors beyond patient preference account for fewer PCIs in black patients.
-
The black widow spider (BWS), which is a member of the arthropod family, is widely distributed on earth. Black widow spider bites can cause a wide variety of signs or symptoms in humans, but the cardiovascular manifestations are relatively rare except hypertension/hypotension and bradycardia/tachycardia. We report on a 65-year-old man who experienced myocarditis after BWS envenomation, which is extremely rare. ⋯ His ECG readings and cardiac enzymes returned to normal with supportive treatment, and he was discharged with complete recovery. To the best of our knowledge, the present case is the third in the literature reporting myocarditis and the first reporting ST-segment elevation and accompanying augmentation in T-wave amplitude after BWS envenomation. In addition to usual measures, we recommend ECG and cardiac-specific enzyme followup for every patient envenomated by BWS for potentially fatal cardiac involvement.
-
This study examined the magnitude of association between alcohol misuse and recent depressive symptoms. ⋯ The findings of this study yield information that could be used by ED health care practitioners and health educators to educate ED patients at risk for alcohol misuse and depression.
-
Comparative Study
Perpetrators of intimate partner violence use significantly more methamphetamine, cocaine, and alcohol than victims: a report by victims.
Our objectives were (1) to determine demographic characteristics of intimate partner violence (IPV) victims and perpetrators, as reported by victims in a Victim Assistance Unit where police are called to the scene for IPV, and (2) to compare the relative risk of methamphetamine, cocaine, and alcohol use in perpetrators vs victims of IPV, as reported by victims. ⋯ By victim report, perpetrators were more likely to have witnessed IPV as children. By victim report, perpetrators were also more likely to use methamphetamine, cocaine, and alcohol and other drugs. Knowing this correlation may be important to the emergency department physician as screening for drug use, especially methamphetamine, as well as IPV may be useful to identify IPV-related injuries and provide proper referrals for IPV and drug use treatment.
-
Case Reports
Acute respiratory failure associated with polymethyl methacrylate pulmonary emboli after percutaneous vertebroplasty.
We report a case of symptomatic polymethyl methacrylate pulmonary emboli after percutaneous vertebroplasty to alert clinicians to this potential cause of pulmonary emboli. A 77-year-old woman developed acute respiratory failure after multilevel percutaneous vertebroplasty. She received mechanical ventilatory support and anticoagulation with low-molecular-weight heparin and warfarin. ⋯ Polymethyl methacrylate cement extravasation into the vertebral venous circulation is common during vertebroplasty. Pulmonary embolism caused by cement migration after this procedure is extremely rare, as reported in the literature to date. However, the frequency of this complication may increase secondary to the widespread use of percutaneous vertebroplasty and kyphoplasty for osteoporotic compression fractures.