The American journal of emergency medicine
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Observational Study
Posterior reversible encephalopathy syndrome in the emergency department: A single center retrospective study.
Posterior Reversible Encephalopathy Syndrome (PRES) and the related term Reversible Posterior Leukoencephalopathy Syndrome (RPLS) denote a constellation of clinical symptoms paired with key radiological findings. These symptoms may include headache, altered mental status, visual changes, and seizures. PRES is a rare condition and remains a challenging diagnosis to make in the emergency department. Data on risk factors and clinical presentation are limited, and there is no recent literature-supported diagnostic criteria. Our primary objective was to identify initial symptoms, clinical presentation, and risk factors that should guide the emergency clinician to consider a diagnosis of PRES. A secondary objective was to identify associations between risk factors and the outcomes of mortality and ICU admissions. ⋯ PRES is difficult to identify and diagnose in the emergency department. Significant risk factors such as female gender, hypertension, and those currently undergoing active immunotherapy/chemotherapy are associated with PRES. Common presenting complaints and exam findings include headache, altered mental status, and neurologic deficits. Emergency providers should consider PRES in patients presenting with altered mental status with significant risk factors, especially with neurologic deficits for which stroke has been ruled out.
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As the United States' population ages, the health care system will experience overall change. This study aims to identify factors in the older adult that may contribute to involuntary hold status in the ED. ⋯ Involuntary older adult patients present with medical comorbidities that impact mental health. In the ED, they are less likely report substance use, and drug screening may be underutilized. Medical needs make their care unique and may present challenges in transfer of care to inpatient psychiatric facilities.
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Observational Study
The prognostic value of HEART score in patients with cocaine associated chest pain: An age-and-sex matched cohort study.
HEART score is widely used to stratify patients with chest pain in the emergency department but has never been validated for cocaine-associated chest pain (CACP). We sought to evaluate the performance of HEART score in risk stratifying patients with CACP compared to an age- and sex-matched cohort with non-CACP. ⋯ In patients with CACP, HEART score performs poorly in stratifying risk and is not recommended as a rule out tool to identify those at low risk of MACE.
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Comparative Study
Practical assessment of different saw types for field amputation: A cadaver-based study.
Field amputation can be life-saving for entrapped patients requiring surgical extrication. Under these austere conditions, the procedure must be performed as rapidly as possible with limited equipment, often in a confined space, while minimizing provider risk. The aim of this study was to determine the ideal saw, and optimal approach, through bone or joint, for a field amputation. ⋯ The speed, precision, safety, space required, as well as the adjustable blade of the oscillating saw make it ideal for a field amputation. A Gigli saw is an excellent backup for when electrical tools cannot be used. Through bone amputation is faster than a through joint amputation.
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Electric scooters (e-scooters) have become a widespread method of transportation. The purpose of this study is to provide risk stratification tools for modifiable risk factors associated with e-scooter injury morbidity. ⋯ There is a substantial proportion of major trauma within e-scooter injuries. Modifiable risk factors for hospital admission include use of head protection and substance use while riding e-scooters.