The American journal of emergency medicine
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Case Reports
Case report and review: Potts disease and epididymal tuberculosis presenting as back pain and scrotal mass.
Tuberculosis (TB) is the world's leading infectious disease killer after AIDS [Tubercle. 1991;72:1-6; Lancet. 2003;362(9387):887-899]. Vertebral TB is the most common form of skeletal TB [Spine. 1997; 22(15):1791-1797], whereas male genital TB is an uncommon form of extrapulmonary TB [Urol Clin North Am. 2003;30(1):111-121]. ⋯ He was subsequently diagnosed with tuberculosis spondylitis (Potts disease) and epididymal tuberculosis. The epidemiology, clinical presentation, diagnosis, and treatment of tuberculosis spondylitis are discussed.
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There are no clear recommendations for the diagnostic evaluation of patients who present to the emergency department (ED) with asymptomatic elevated blood pressure. In patients presenting with asymptomatic elevated blood pressure in the ED, we measured the prevalence of abnormalities on a basic metabolic profile (BMP) that led to hospital admission as well as the prevalence of diminished renal function. ⋯ In a homogenous African American population presenting to the ED with asymptomatic elevated BP, there is a relatively high prevalence of abnormalities on the BMP that led to hospital admission. We suggest routine testing of a serum creatinine should be strongly considered in a largely African American patient population with asymptomatic elevated BP in the ED.
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Randomized Controlled Trial Comparative Study
Comparison of ultrarapid and rapid intravenous hydration in pediatric patients with dehydration.
The purpose of this study is to test the efficacy of ultrarapidly infused vs rapidly infused intravenous (IV) hydration in pediatric patients with acute gastroenteritis and moderate dehydration. ⋯ Based on this pilot study, ultrarapid hydration for 1 hour preliminarily appears to be an efficacious alternative to standard rapid hydration for 3 hours and improves emergency department throughput time.
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A previous study showed that pulmonary edema patients presenting between noon and 4 pm have the highest rates of myocardial infarction and death. We hypothesized that the highest intubation rates would also occur at these times. ⋯ We found significant circadian variation in intubation rates, with a marked increase around midnight. Pathological mechanisms causing patients with congestive heart failure to require intubation may differ from those resulting in myocardial infarction or death.
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Outcomes from low versus high-flow cardiopulmonary resuscitation in a swine model of cardiac arrest.
Return of spontaneous circulation (ROSC) is improved by greater vital organ blood flow during cardiopulmonary resuscitation (CPR). We tested the hypothesis that myocardial flow above the threshold needed for ROSC may be associated with greater vital organ injury and worse outcome. ⋯ High-flow CPR significantly improved arrest hemodynamics, rates of ROSC, and post-ROSC indicators of myocardial status, all indicating less injury with higher flows. No evidence of organ injury from vital organ blood flow substantially above the threshold for ROSC was found.