The American journal of emergency medicine
-
Randomized Controlled Trial Comparative Study
Randomized comparison of three guidewire insertion depths on incidence of arrhythmia during central venous catheterization.
Guidewire-induced arrhythmias that occur during central venous catheterization can progress to malignant arrhythmias in rare cases. This study compared the incidence of arrhythmia during central venous catheterization using three different depths of guidewire insertion into the right internal jugular vein. ⋯ During central venous catheterization through the right internal jugular vein, inserting guidewires to depths of 15 or 17.5cm before tissue dilation reduced the incidence of arrhythmic episodes compared to a depth of 20cm.
-
The effect of the Affordable Care Act on emergency department (ED) high utilizers has not yet been thoroughly studied. We sought to determine the impact of changes in insurance eligibility following the 2014 Medicaid expansion on ED utilization for ambulatory care sensitive conditions (ACSC) by high ED utilizers in an urban safety net hospital. ⋯ Although the proportion of high utilizers decreased significantly after Maryland's Medicaid expansion, ACSC-associated ED visits by high ED utilizers were unaffected.
-
We present a case of pyelonephritis following the extended andsolitary use of over-the-counter phenazopyridine in a forty-year-oldfemale. The patient initially had uncomplicated cystitis signs andsymptoms which partially resolved with phenazopyridine and therefore she continued use. ⋯ As phenazopyridine is devoidof antibacterial properties this allowed the lower urinary tractinfection to progress to acute pyelonephritis requiring intravenousantibiotics. Better patient education may preclude this complication.
-
Multicenter Study Comparative Study Observational Study
Missed myocardial infarctions in ED patients prospectively categorized as low risk by established risk scores.
Few studies have prospectively compared multiple cardiac risk prediction scores. We compared the rate of missed acute myocardial infarction (AMI) in chest pain patients prospectively categorized as low risk by unstructured clinical impression, and by HEART, TIMI, GRACE, and EDACS scores, in combination with two negative contemporary cardiac troponins (cTn) available in the U.S. ⋯ Using their recommended cutpoints and non high sensitivity cTn, TIMI and unstructured clinical impression were the only scores with no missed cases of AMI. Using lower cutpoints (GRACE≤48, TIMI=0, EDACS≤11, HEART≤2) missed no case of AMI, but classified less patients as low-risk.