The American journal of emergency medicine
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Multicenter Study Observational Study
CLIF-OF >9 predicts poor outcome in patients with Amanita phalloides poisoning.
Amanita phalloides poisoning with high mortality is rare but serious. The aim of this study is to identify the risk indicators of death in patients with Amanita phalloides poisoning and a good score tool to predict prognosis. ⋯ CLIF-OF (>9) within 24 h of admission is considered as a satisfactory and practical tool to predict a poor outcome of Amanita phalloides poisoning.
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Observational Study
Diagnosis of aortic dissection by transesophageal echocardiography during cardiopulmonary resuscitation.
Early identification of the causes of cardiac arrest is helpful in determining the resuscitation measures during cardiopulmonary resuscitation (CPR). We aimed to evaluate the feasibility of transesophageal echocardiography (TEE) during CPR in diagnosing aortic dissection and the influence of aortic dissection on resuscitation outcome in adult patients with prolonged non-traumatic cardiac arrest. ⋯ TEE is a useful tool for diagnosing aortic dissection as a cause of cardiac arrest during CPR. Aortic dissection is associated with poor resuscitation outcomes.
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Early diagnosis of blunt cerebrovascular injury (BCVI) is among the most difficult challenges in trauma treatment. This study aimed to determine the optimal timing of computed tomographic angiography (CTA) screening for suspicious BCVI in patients with polytrauma. ⋯ For patients with polytrauma, performing brain CTA for BCVI screening in the first 24-h or after may not affect clinical outcome. Initial motor response is the sole indicator for outcome. Delaying the study for to the next 24-hour can be considered in such patients, when regarding hemodynamic stability, the dose of contrast medium, and the radiation exposure.
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Comparative Study
The utilization of CTA in management of gastrointestinal bleeding in a tertiary care center ED. Are we using it enough?
Gastrointestinal (GI) bleeding is a common patient presentation to the Emergency Department (ED) and the source can be difficult to diagnose. ⋯ We concluded that in light of its validation against these other diagnostic modalities, CTA may be underutilized in the care of patients with GI bleeding and should be studied further to study its impact on early risk stratification, treatment, and resource utilization.
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A 40-year-old female presented to the ED with a history of intermittent headaches since a vaginal delivery 8 days prior. Her pregnancy was unremarkable and was not complicated by pre-eclampsia. She did not present with signs or symptoms consistent with postdural puncture headache or pre-eclampsia. ⋯ First-line pharmacological treatment consists of high-dose corticosteroids and is effective in reducing pituitary size and improving endocrine insufficiency in 75% of cases. LH is a potential cause of postpartum headache that can be easily screened for with history and routine bloodwork and has good outcomes with early intervention. LH should be added to the differential for postpartum headaches presenting to the emergency department and routine blood work should be considered for all postpartum headaches.