The American journal of emergency medicine
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Observational Study
An evaluation of single question delirium screening tools in older emergency department patients.
To determine the diagnostic performances of several single question delirium screens. To the patient we asked: "Have you had any difficulty thinking clearly lately?" To the patient's surrogate, we asked: "Is the patient at his or her baseline mental status?" and "Have you noticed the patient's mental status fluctuate throughout the course of the day?" ⋯ The patient and surrogate single question delirium assessments may be useful for delirium screening in the ED.
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A 57-year-old male former smoker presented to the Emergency Department (ED) with blurry vision, headache, and generalized weakness. He was hypoxic on room air and ECG showed sinus tachycardia. A CT pulmonary angiogram was ordered in the ED and revealed no pulmonary embolism but incidentally noted a likely significant stenosis in the proximal LAD. ⋯ Unlike coronary CTA, CTPA is performed with non-ECG gated helical scanning and generates motion artifacts associated with myocardial contraction. However, the timing of vascular contrast opacification during CTPA often allows for at least partial evaluation of the coronary arteries, especially ostial and proximal segments. Physicians ordering and evaluating noncardiac-focused CT chest studies, particularly in the ED, should remain cognizant of the radiographic appearance of underlying CAD, particularly life-threatening incidental coronary pathologies to allow for timely management and intervention.
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Many patients transported by emergency medical services (EMS) may require advanced cardiac care but do not have ST-segment elevation (STEMI) on the initial prehospital EKG. We sought to identify factors associated with the need for advanced cardiac care in undifferentiated EMS patients reporting chest pain in the absence of STEMI on EKG. ⋯ We have identified several factors that could be considered when risk stratifying prehospital patients reporting chest pain. While potentially predictive, the factors are broad and support the need for other objective factors that could augment prediction of patients who may benefit from early advanced cardiac care.
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Case Reports
Pseudo-Wellens' syndrome and intermittent left bundle branch block in acute cholecystitis.
We present a case of a 54-year-old male patient who was admitted to our Emergency Department (ED) with localized epigastric pain. Inflammation markers, ultrasound, and CT scan were inconsistent with an initial diagnosis of cholecystitis. However, there was additional evidence of cholecystolithiasis. ⋯ A laparoscopic study confirmed acute cholecystitis. Coronary angiography showed no pathological processes associated with ACS. ECG abnormalities were initially ongoing, but were no longer detectable during an 8month follow up assessment.
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Patients who experience trauma with severe hemorrhage requiring immediate surgery and massive blood transfusion often present with markedly abnormal laboratory values. These cases require valuable resources; however, little is known regarding prognostic factors that correlate with mortality. The purpose of this study was to determine whether abnormal initial arterial blood gas (ABG) pH, a marker for severe blood loss, could serve as a prognostic indicator for these patients. ⋯ Consideration should be given to initial pH values when resuscitating "red blanket" patients. However, the pH values alone cannot reliably be used to determine clinical futility in individual patients in the early period after injury.