The American journal of emergency medicine
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Regular, narrow complex tachycardia with a ventricular rate around 150 can be challenging. The differential includes sinus tachycardia, atrioventricular nodal reentrant tachycardia (AVNRT), atrioventricular reentrant tachycardia (AVRT), and atrial tachycardia (focal or macro re-entrant - i.e. flutter). We present a case of a 90-year-old woman presenting with shortness of breath in which the ECG was not diagnostic, but the presence of regular neck pulsations helped secure the diagnosis of AVNRT. ⋯ When the right atrium attempts to contract against a closed tricuspid valve, an abrupt increase in venous pressure is encountered. This increase in venous pressure manifests as prominent neck pulsations termed "cannon A waves." The patient was ultimately successfully electrically cardioverted resulting in resolution of her presenting symptoms, neck pulsations, and tachycardia. While irregular "cannon A waves" can be seen in conditions of AV dissociation, regular "cannon A waves" strongly favor the diagnosis of AVNRT.
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Diagnostic tests are widely used for patients with syncope in the emergency department (ED). This study aimed to determine the diagnostic yield of neuroimaging in patients with syncope without high-risk symptoms. ⋯ Neuroimaging is not beneficial in patients whose medical history and physical examination do not indicate neurogenic syncope, even if the patient has mild head trauma.
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Comment Letter
Impact of prehospital airway management on combat mortality.
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Observational Study
Delayed endoscopy is associated with increased mortality in upper gastrointestinal hemorrhage.
To determine the association between delayed (>24 h) endoscopy and hospital mortality in patients with upper gastrointestinal hemorrhage (UGIH). ⋯ Endoscopy performed after 24 h was associated with increased hospital mortality in UGIH. Patients in the delayed group stayed longer in the ED and in the hospital.
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Observational Study
Septic acute kidney injury patients in emergency department: The risk factors and its correlation to serum lactate.
Acute kidney injury (AKI) is a common complication in septic patients, imposing a heavy burden of illness in terms of morbidity and mortality. Serum lactate is a widely used marker predicting the severity of sepsis. A paucity of research has investigated septic AKI in emergency departments (EDs) and its correlation with initial serum lactate level. This study aimed at identifying risk factors for septic AKI and clarifying the link between initial serum lactate level and septic AKI in ED patients. ⋯ Patients with septic AKI had an overwhelmingly higher mortality rate. The comorbidities of liver disease, diabetes mellitus, and chronic kidney disease were correlated with septic AKI and in combination with an elevated initial serum lactate level had predictive regarding AKI and further mortality in ED septic patients.