The American journal of emergency medicine
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The aim of the study was to determine whether C-reactive protein (CRP), procalcitonin (PCT), and d-dimer (DD) are markers of mortality in patients admitted to the emergency department (ED) with suspected infection and sepsis. ⋯ Our results suggest that high levels of DD are associated with 28-day mortality in patients with infection or sepsis identified in the emergency department.
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Case Reports
Simultaneous left anterior descending and right coronary stent thrombosis after aspirin withdrawal.
ST-segment elevation myocardial infarction is usually caused by plaque rupture and subsequent thrombosis of a single culprit vessel. In rare occasions, simultaneous thrombosis of 2 coronary arteries occurs, which is usually associated with a worse prognosis. ⋯ This case raises concerns with drug-eluting stents due to the higher potential for late stent thrombosis related to delayed endothelialization of the stent struts. Physicians should be very cautious when deciding to withdraw antiplatelet therapy preoperatively to avoid rebound coronary thrombosis.
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Novel facilities such as an intensive observation unit and an outpatient clinic could result in improving management of patients presenting with atrial fibrillation (AF). ⋯ In patients with AF, beyond the standard approach, the novel organization with an additional intensive observation unit for early pharmacological interventions and an outpatient clinic for elective treatment and short-term follow-up significantly reduced admission irrespective of independent predictors of hospitalizations. Patients without structural heart disease treated with antiarrhythmic drugs achieved sinus rhythm in 89% of cases, mostly with class IC drugs.
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Patients are often referred to the emergency department for further evaluation, yet the astute physician will maintain a broad differential to avoid anchoring on prior diagnoses. In this case, a 56-year-old man was referred to our emergency department from the radiology suite secondary to concerns for an “allergic reaction” to prior magnetic resonance imaging contrast. ⋯ A chest x-ray that demonstrated right mediastinal mass was ordered, and a computed tomographic scan confirmed compression of the superior vena cava. A brief discussion on the history, etiologies, presentation, and evaluation of superior vena cava syndrome is discussed.
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Recent work has shown that two-thirds of patients report functional disability 1 week after an emergency department (ED) visit for nontraumatic musculoskeletal low back pain (LBP). Nearly half of these patients report functional disability 3 months later. Identifying high-risk predictors of functional disability at each of these 2 time points will allow emergency clinicians to provide individual patients with an evidence-based understanding of their risk of protracted symptoms. ⋯ Patients in the ED with worse baseline functional impairment and a history of chronic LBP are 2 to 4 times most likely to have poor short- and longer-term outcomes.