The American journal of emergency medicine
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The Glasgow-Blatchford Bleeding Score (GBS) and Rockall Score (RS) are clinical decision rules that risk stratify emergency department (ED) patients with upper gastrointestinal bleeding (UGIB). We evaluated GBS and RS to determine the extent to which either score identifies patients with UGIB who could be safely discharged from the ED. ⋯ Although GBS outperformed pre-endoscopy RS, the prognostic accuracy of GBS and post-endoscopy RS was similarly high. The specificity of GBS and RS was insufficient to recommend use of either score in clinical practice.
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The anterolateral abdominal wall is innervated by the T7 to L1 anterior rami, whose nerves travel in the fascial plane between the internal oblique and transversus abdominus muscles, known as the transversus abdominus plane (TAP). Ultrasound-guided techniques of regional anesthesia that target the TAP are increasingly relied upon by anesthesiologists for pain management related to major abdominal and gynecologic surgeries. Our objective was to explore the potential utility of these techniques to provide anesthesia for abdominal wall procedures in the emergency department (ED). ⋯ In a series of 4 ED patients, ultrasound-guided TAP and ilioinguinal/iliohypogastric blocks performed by emergency physicians provided excellent procedural anesthesia. Further study of these techniques as an alternative to sedation for ED patients undergoing abdominal wall procedures is warranted.
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Case Reports
Subacute anterior wall myocardial infarction complicated by intramyocardial dissection.
Myocardial dissection is a rare but fatal complication of myocardial infarction requiring urgent surgical treatment to avoid complete rupture. We report a case of intramyocardial dissecting hematoma treated with supportive pharmacologic therapy for 9 months of follow-up without surgical intervention.
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Young patients are at low risk for an acute coronary syndrome (ACS); however, many of these patients still enter a "rule-out ACS" pathway and receive stress testing. We hypothesized that stress testing in patients younger than 40 years without known coronary disease will not identify patients at high risk for 30-day adverse cardiovascular events. ⋯ The 30-day cardiovascular complication rate is not different between young patients without known heart disease who do and do not receive stress testing when they present with symptoms of a potential ACS. Testing of young patients at low risk for disease should be reconsidered.
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Our study compares treatment times of morbidly obese patients (body mass index [BMI]>40 kg/m2) with patients having BMI less than 35 kg/m2. ⋯ In our institution, morbidly obese patients take significantly longer to disposition home than patients of more normal weight.