The American journal of emergency medicine
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Comparative Study Clinical Trial
Noninvasive continuous or intermittent blood pressure and heart rate patient monitoring in the ED.
Continuous invasive blood pressure (BP) and heart rate (HR) monitoring in the emergency department (ED) is valuable in managing critically ill patients. Novel noninvasive finger cuff technology allows this same uninterrupted monitoring for almost any individual. This exploratory study compares ED noninvasive continuous to intermittent measurements of these variables. ⋯ Continuous BP and HR monitoring measured by the Nexfin finger cuff device in this trial showed reasonable agreement when compared with the intermittent values obtained by automated ED equipment. However, theoretically, noninvasive and continuous monitoring of the BP and HR might better reflect underlying hemodynamics than these same measurements obtained intermittently and, thus, could be important in patient management. More study is needed to determine the optimal method of monitoring these parameters.
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A 75-year-old male patient suffered a chest degloving injury when he fell on his back and was run over by a small farm tractor he was pulling. At the time of patient admission, the paradoxical motion of the right chest wall was remarkable; and he had an open fracture of the right humerus, a dislocation of the right ankle, and a laceration of the right forearm. ⋯ Because the right flail chest was severe and there was a large amount of air leakage that continued under positive-pressure ventilation for pneumatic stabilization, we performed surgical fixation of the ribs and repaired the lung injury on the fifth hospital day. The patient's postoperative course was uneventful.
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Case Reports
Evaluation of proper above-the-diaphragm central venous catheter placement: the saline flush test.
hest radiographs are routinely obtained after the insertion of above-the-diaphragm central venous catheters to confirm placement and detect mechanical complications. At times, performing the radiograph can be time-consuming and findings may be inaccurate. We present a case of a patient with difficult access who required emergent resuscitation. ⋯ Other investigators have demonstrated different methods to confirm central venous catheter placement by bedside ultrasound, utilizing multiple views, Doppler technology, or microbubble contrast. This novel technique, as described here, is most simple. Further research is needed to demonstrate accuracy and utility.
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Identifying acute pyelonephritis (APN) with early obstructive uropathy is clinically important in the emergency department (ED) because obstructive urolithiasis is an independent risk factor for inpatient death, prolonged hospitalization, and failure of outpatient APN therapy. Furthermore, diagnosis of an early obstructive uropathy can be difficult when based solely on clinical findings. Clinicians may assume the cause of the patient's symptoms to be APN alone, without considering the concurrent presence of an obstructing stone. ⋯ In this case, hydronephrosis on bedside ultrasound examination was an indirect marker of a distal ureteral obstruction. By detecting the presence of hydronephrosis in patients with APN, emergency physicians may dramatically increase their ability to identify those patients that need further radiographic investigation and ultimately decrease the rate of outpatient treatment failure. Further surveillance data are needed to determine the statistical characteristics of this novel screening test and if routine renal evaluation of all patients with APN is warranted.
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Acute hepatotoxicity is a rare but potentially fatal complication of amiodarone use. Although oral long-term use of the drug is frequently complicated by an asymptomatic rise in serum aminotransferase concentrations, acute hepatotoxicity during intravenous loading is much less frequent and potentially fatal. We report a case of liver injury after intravenous administration in a patient with atrial fibrillation.