The American journal of emergency medicine
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We describe our preliminary experience with coronary computed tomography angiography (CCTA) in emergency department (ED) patients with low- to intermediate-risk chest pain. ⋯ Many ED patients with low- to intermediate-risk chest pain have a normal or nonobstructive CCTA and may be safely discharged from the ED without any associated mortality within the following 6 months.
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Case Reports
Delayed herniation of intra-abdominal contents after blunt right-sided diaphragm rupture.
Right diaphragmatic hernia is a rare injury (0.25%-1%) after blunt abdominal trauma. The diagnosis may be delayed and achieved years after the trauma. We currently report a case of a 48-year-old man who presented to the emergency department at Far Eastern Memorial Hospital, New Taipei City, Taiwan, demonstrating signs of herniation of the right diaphragm. ⋯ The diagnosis was further confirmed through thoracoabdominal computed tomography. The diaphragmatic hernia was subsequently repaired via abdominal approach. For patients with a history of prior thoracoabdominal trauma with complaints of new abdominal pain, a delayed diaphragmatic hernia should be considered.
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Electrical storm is a challenging diagnosis for the clinician and requires detailed evaluation of the patient. Amiodarone is frequently used for the cessation of ventricular tachycardia attacks. ⋯ Thyrotoxicosis may alter arrhythmia and lead to frequent ventricular tachycardia attacks. Herein, we report a case of electrical storm caused by amiodarone-induced thyrotoxicosis.
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Approximately 5% of all US emergency department (ED) visits are for chest pain, and coagulation testing is frequently utilized as part of the ED evaluation. ⋯ Coagulation testing on chest pain patients in the ED is not cost-effective and should not be routinely performed.
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Pulse CO-oximetry (Rad-57; Masimo Corp, Irvine, CA) has been available since 2005. To date, all published clinical studies have focused on clinical reliability and whether the device enhances case finding through screening of various populations. This study examines whether use of pulse CO-oximetry shortens the time to diagnosis and treatment of patients with carbon monoxide (CO) poisoning. ⋯ Pulse CO-oximetry is associated with more rapid diagnosis and initiation of hyperbaric oxygen therapy in CO-poisoned patients compared with laboratory CO-oximetry. The impact on clinical outcome remains to be determined.