The American journal of emergency medicine
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Review Case Reports
Diverse presentation of spontaneous rupture of urinary bladder: review of two cases and literature.
The objective of the study was to highlight diagnostic dilemmas and suggest pointers toward early diagnosis of spontaneous rupture of urinary bladder based on case study of 2 patients diagnosed as a case of spontaneous rupture of urinary bladder. A 26-year-old man presented with painless progressive abdominal distension of 1-week duration. In absence of acute abdominal symptoms and signs, the diagnosis of chronic liver disease with ascites was entertained. ⋯ Spontaneous rupture of urinary bladder is extremely rare with only very few reports available in literature. High creatinine levels in the peritoneal fluid aspirate of the first patient and the blood-stained urine in the second patient were pointers toward possibility of urinary bladder rupture. Rupture of urinary bladder should always be considered in differential diagnosis of patients presenting with free fluid in abdomen/peritonitis, decreased urine output, hematuria and in whom increased level of urea/creatinine are detected in serum and/ or peitoneal fluid aspirate.
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Multicenter Study
Relationship between the hemoglobin level at hospital arrival and post-cardiac arrest neurologic outcome.
The hemoglobin (Hb) level is an essential determinant of oxygen delivery. The restoration of blood perfusion to vital organs and the capacity for oxygen delivery may be associated with ischemia and reperfusion injuries during cardiac arrest and after cardiac arrest. However, whether the Hb level is associated with neurologic outcome in post-cardiac arrest patients remains unclear. ⋯ A higher Hb level at the time of hospital arrival was associated with a favorable short-term neurologic outcome among post-cardiac arrest patients with a presumed cardiac etiology.
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The objective of the study was to compare errors in the emergency department (ED) with pharmacists present (PPs) for resuscitations and traumas vs with pharmacists absent (PAs). Our hypothesis was that errors would be significantly fewer during PP than PA times. We also hypothesized that times with PP would affect patients greater when disposition was to more critical areas (intensive care unit, or ICUs). ⋯ With pharmacists absent, over 13 times more errors are recorded in our ED than with pharmacists present. An on-site pharmacist in the ED may be helpful in reducing medical errors.
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Comparative Study
Acute heart failure registry from high-volume university hospital ED: comparing European and US data.
Acute heart failure (AHF) is associated with a poor prognosis. ⋯ The patient's blood pressure, ejection fraction, and hemoglobin values, at admission, were identified as the strongest predictors of all-cause mortality. In AHF not triggered by acute MI, long-term use of statins may be associated with reduced survival. The prevalence of diastolic AHF is low. The American AHF population had similar baseline characteristics; needed fewer intensive care unit admissions; had a better 30 days of prognosis, lower incidence of MI, and de novo AHF diagnoses. In a similar subgroup, we observed similar incidences of inotropic support and mechanical ventilation. Our results could not be generalized to all patients with AHF admitted to US EDs.