The American journal of emergency medicine
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We sought to identify predictors for a drainable suppurative adenitis [DSA] among patients presenting with acute cervical lymphadenitis. ⋯ We identified independent predictors of DSA among children presenting with cervical adenitis. Risk can be stratified into risk groups based on these clinical features.
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This paper discusses a possible weakness of the HEART Pathway specific to patients identified as high risk, requiring admission for inpatient risk stratification. Emergency Department (ED) crowding is at an all-time high and the possibility that many of these patients will board in the ED for a period of time before they are transported to an inpatient ward is becoming more likely. Given troponins peak at 6 h after the initial cardiac injury, it is plausible an initial troponin could still remain negative upon arrival. ⋯ The patient then received further management in the ED and a change in admission to the Cardiac Care Unit instead of the medicine floor. The patient ultimately received a Coronary Artery Bypass Graft during admission. If the patient had not had the second troponin while in the ED this care would have been delayed.
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Case Reports
More than meets the eye: Point-of-care ultrasound diagnosis of acute optic neuritis in the emergency department.
Optic neuritis (ON) is an inflammatory condition that causes demyelination and thickening of the optic nerve leading to acute/subacute vision loss. It is frequently associated with other conditions like multiple sclerosis, but is often misdiagnosed, which can lead to a suboptimal prognosis. Ultrasound is rarely utilized to help make this diagnosis, even though it can easily detect a thickened retrobulbar optic nerve sheath diameter. We describe four cases in which ultrasonographic measurement of the optic nerve sheath diameter aided in the diagnosis of ON.
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Case Reports
Anterior wall ventricular pseudoaneurysm presenting as dizziness and syncope: A case report.
Ventricular pseudoaneurysm rupture is a rare finding in emergency departments in the era of percutaneous coronary intervention. It is an infrequent complication after acute myocardial infarction. We present a case of ventricular pseudoaneurysm rupture and examine current literature on the pathophysiology and imaging guidelines on the topic. ⋯ He was treated surgically. Ventricular pseudoaneurysm rupture is an uncommon finding in medicine and the emergency department. Point-of-care ultrasound is an important diagnostic modality to identify this critical complication and prompt surgical management.