The American journal of emergency medicine
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Kidney stone related complaints in the Emergency Department (ED) are common. Current guidelines recommend antibiotic therapy for infected obstructive stones and stone removal in a timely fashion, but there is no clear recommendation for prophylactic antibiotic use for bacteriuria or pyuria in the setting of obstructive ureteral stones. ⋯ Antibiotics were given at the discretion of the provider without clear pattern. A high rate of infectious complication did not occur in the followed up patient group.
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Comparative Study Clinical Trial
The diagnostic efficacy of cardiac CTA combined with D-dimer assay for the detection of left atrial thrombus in patients with atrial fibrillation.
We aimed to evaluate a combination diagnostic method of single-phased, single-contrast injection cardiac computed tomography angiography CTA combined with age-adjusted D-dimer assay for diagnosis of left atrial/left atrial appendage (LA/LAA) thrombus in comparison to transesophageal echocardiography (TEE) in patients with atrial fibrillation. The addition of D-dimer to the CTA is to increase specificity, since CTA is part of the combined method. ⋯ The combination diagnostic method comprising single-phase, single-contrast injection cardiac CTA and age-adjusted D-dimer assay had good diagnostic efficacy for the detection of LA/LAA thrombus in patients with AF. The combination diagnostic method had significantly better specificity and PPV than cardiac CTA alone. The presented diagnostic approach could potentially facilitate rapid diagnosis or exclusion of left atrial thrombus under emergency situation or when TEE is un-available, with good diagnostic efficacy and no TEE related risks.
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Observational Study
Interexaminer reliability of pharyngeal injection and palatine tonsillar hypertrophy in a pediatric emergency department.
To evaluate the interrater reliability of throat examinations in children according to the major and training stage. ⋯ Examiners' agreement for PTH was more reliable than that for PI when evaluating children who visited the ED. The interrater reliability did not improve with increased clinical experience. These findings should be considered in the examination of pharyngeal pathology.
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The objective of this study was to determine the effectiveness and safety of four-factor prothrombin complex concentrate (4F-PCC) for the reversal of factor Xa inhibitors in patients with traumatic intracranial hemorrhage (ICH). ⋯ Patients with a higher ISS received 4F-PCC preferentially, which led to an apparent mortality benefit the no reversal group. After adjusting for baseline differences between groups, there was no difference in mortality, functional recovery, hospital and ICU LOS, or thromboembolic complications.
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Case Reports
A unique case of bradycardia recognized by wearable technology as first presentation of complete heart block.
Wearable technology has advanced significantly, and the proposed health benefits have been widely touted. Most of the discussion has been surrounding the identification and diagnosis of asymptomatic atrial fibrillation. ⋯ Wearable technology has advanced significantly, but still poses questions regarding its use in screening for rare conditions. One remaining challenge is balancing the desire to screen for rare asymptomatic conditions without overburdening emergency departments with patients responding to alarms on their devices.