The American journal of emergency medicine
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Observational Study
Point-of-care lung ultrasound in children with non-cardiac respiratory distress or tachypnea.
The purpose of this study was to evaluate the feasibility and diagnostic benefit of point-of-care ultrasound (PoCLUS) in children with non-cardiac respiratory distress or tachypnea. ⋯ PoCLUS may constitute a beneficial and rational approach in the evaluation of children with increased work of breathing in the ED, and can also expedite the diagnostic process.
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Case Reports
Acute disseminated encephalomyelitis in children - clinical and MRI decision making in the emergency department.
Acute disseminated encephalomyelitis (ADEM) is an uncommon, treatable, primarily pediatric, immune-mediated disease. Diagnosis of ADEM requires two essential elements: typical clinical presentation and magnetic resonance imaging (MRI) findings. The aim of this study was to evaluate how clinical findings in the initial emergency department (ED) presentation influenced the timing of MRI. ⋯ 20% of ADEM patients were not encephalopathic at ED presentation. Polyfocal neurological signs and absence of fever at ED presentation were related to earlier MRI utilization and thus earlier diagnosis and treatment. Familiarity with the ADEM constellation of signs, and a high index of suspicion, may help the ED clinician in early diagnosis and treatment of this rare disease.
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Clinical Trial
The value of ischemia-modified albumin and oxidative stress markers in the diagnosis of acute appendicitis in adults.
The present study evaluates the predictive value of such markers as ischemia-modified albumin (IMA), malondialdehyde (MDA) and glutathione peroxide (GSH-Px), in addition to parameters associated with inflammation, oxidative stress and ischemia, playing roles in the pathology of acute appendicitis (AA), including c-reactive protein (CRP), procalcitonin (PCT) and complete blood count (CBC) parameters and their ratios, for the diagnosis of AA in adults. ⋯ Our results showed that IMA (negative LR = 0.1), CRP (positive LR = 7.2, negative LR = 0.2), NLR (negative LR = 0.1) and IMA/albumin ratio (negative LR = 0.1) can serve as important diagnostic biomarkers for AA patients. We therefore believe that before clinically confirming an AA diagnosis, these parameters may be used as diagnostic tools in addition to CBC parameters, CRP levels and radiological imaging studies.
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Observational Study
Effect of a legislative mandate on opioid prescribing for back pain in the emergency department.
A change in Arizona State law in 2017 required prescribers to review data from a prescription drug monitoring program (PDMP) prior to opioid prescribing. The objective was to determine the effect of this change on opioid prescribing for patients who presented to the emergency department (ED) for back pain. ⋯ A legislative requirement for provider PDMP review did not change opioid prescribing for patients in the ED who presented with back pain.