The American journal of emergency medicine
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Case Reports
Using suboccipital release to control singultus: a unique, safe, and effective treatment.
Hiccups, or singultus, are the result of spontaneous and repetitive contractions of the diaphragm. In most cases, episodes of singultus are benign and self-limited. However, prolonged attacks can result in significant discomfort, morbidity, and even death. ⋯ With this approach, gentle traction and pressure is applied to the posterior neck, stretching the suboccipital muscles and fascia. The manual decompression of the vagus, and possibly phrenic, nerves interrupts the hiccup reflex and allows for normal autonomic function to be reestablished. We propose that the suboccipital release, noninvasive, simple, and with virtually no side effects, is an ideal initial treatment of singultus.
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The presence of the sonographic sliding lung sign (SLS) is a sensitive indicator for the absence of a pneumothorax. ⋯ Prehospital critical care providers can accurately determine the presence or absence of the sonographic SLS following a brief tutorial and retain the skill set following a 9-month interval.
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Multicenter Study Clinical Trial
Combined copeptin and troponin to rule out myocardial infarction in patients with chest pain and a history of coronary artery disease.
The main objective of this multicentric study was to evaluate the additional value of copeptin to conventional cardiac troponin (cTn) for a rapid ruling out of acute myocardial infarction (AMI) in patients with acute chest pain and a previous history of coronary artery disease (CAD). ⋯ In triage patients with acute chest pain lasting for less than 6 hours and a previous history of CAD, the combination of copeptin and cTn allows for the ruling out AMI, with a negative predictive value greater than 95%.
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Overcrowding is an important issue facing many emergency departments (EDs). Access block (admitted patients occupying ED stretchers) is a leading contributor, and expeditious placement of admitted patients is an area of research interest. This review examined the effectiveness of full capacity protocols (FCPs) on mitigating ED overcrowding. ⋯ Although FCPs may be a promising alternative for overcrowded EDs, the available evidence upon which to support implementation of an FCP is limited. Additional efforts are required to improve the outcome reporting of FCP research using high-quality research methods.