The American journal of emergency medicine
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The study aims to assess if electrocardiographic (ECG) abnormalities could predict the development of neurogenic pulmonary edema (NPE) within 24 hours in cases of spontaneous subarachnoid hemorrhage (SAH). ⋯ Electrocardiographic abnormalities, especially abnormal Q or QS wave and NSSTTCs, may predict the development of NPE within 24 hours in adult patients with spontaneous SAH.
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Hemodynamically unstable patients with supraventricular tachycardias (SVTs) should be treated with electrical cardioversion. If the patient is stable, acute termination of tachycardia can be achieved by vagal maneuvers or medical therapy. The Valsalva maneuver, carotid massage, and ice to the face are the most common vagal maneuvers. ⋯ Then, a short and powerful vagal stimulation occurs. Thus, SVT episodes can be terminated. Here we present our experience of a new maneuver for terminating SVT, with cases.
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Early identification of sepsis in the emergency department (ED), followed by adequate fluid hydration and appropriate antibiotics, improves patient outcomes. ⋯ An EHR-based triage sepsis alert and SWAT protocol led to a significant reduction in the time to intravenous fluids and time to antibiotics in ED patients admitted with suspected sepsis, severe sepsis, and septic shock.
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We report a case of spontaneous, bilateral Achilles rupture in a 33-year-old man with no specific risk factors. The rupture occurred after a heavy impact during a sports activity, and although the rupture was painful, he was able to mobilize slowly. ⋯ The patient's return to premorbid work and social life was uneventful. A spontaneous rupture in a patient without any predisposing risk factors is uncommon, and for it to occur bilaterally is notably rare.
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Patients with cirrhosis have high risk of bacterial infections and cirrhosis decompensation, resulting in admission to emergency department (ED). However, there are no criteria developed in the ED to identify patients with cirrhosis with bacterial infection and with high mortality risk. ⋯ In this cohort of ED patients with decompensated cirrhosis, lymphopenia and elevated C-reactive protein were related to bacterial infections, and elevated creatinine and international normalized ratio were related to mortality. Scores built with these variables should be prospectively validated.