The American journal of emergency medicine
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Case Reports
Central neurogenic hyperventilation secondary to suspected metastatic renal cell carcinoma.
Central neurogenic hyperventilation (CNH) is a neurogenic disorder rarely described within Emergency Medicine literature. CNH is a primary cause of hyperventilation, most commonly due to primary central nervous system neoplasms. Patient presentation varies based on the underlying cause, and may present with a sole chief complaint of dyspnea. ⋯ While the cause of the patient's hemorrhage was not elucidated, given the patient's widely metastatic disease, it was presumed to be secondary to metastasis. Our case highlights both a unique cause of a rare disorder of hyperventilation, and a diagnostic challenge to the emergency medicine provider. It is important to consider central causes of hyperventilation in patients with dyspnea and neurologic symptoms.
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Patients with small intracranial hemorrhage at initial presentation (ICHi) have a relatively uneventful hospital course, as compared with larger ICHi. In this study, we tested the null hypothesis that ICHi does not impact the symptom profile of patients with traumatic brain injury (TBI) after discharge. ⋯ ICHi does not impact the symptom profile of patients with TBI in either short or long term.
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Antibiotic stewardship programs have been a major focus in recent years to curtail antibiotic resistance. The purpose of this study was to evaluate antibiotic utilization for acute respiratory tract infections (ARTI) in the Emergency Department (ED) setting. ⋯ We found a significant reduction in the utilization of antibiotics among adult ARTI visits to U.S. EDs from 2011 to 2017. This is an improvement from previous studies which showed no change, suggesting that antimicrobial stewardship efforts may be impacting overall antibiotic use and should continue to be practiced.
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The primary purpose of this study was to evaluate trends in ambulance utilization and costs among Medicare beneficiaries from 2007 to 2018. Community characteristics associated with ambulance use and costs are also explored. ⋯ Numerous policy solutions have been proposed to address growing ambulance costs in the Medicare program. While ambulance transports and costs continue to increase, a bend in the ambulance cost curve is detected suggesting that one or more policies altered Medicare ambulance costs, although utilization has continued to grow linearly. Ambulance use and costs vary significantly with community-level factors. As policy makers consider how to address growing ambulance use and costs, targeting identified community-level factors associated with greater costs and utilization, and their root causes, may offer a targeted approach to addressing current trends.
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This study aimed to make a comparison between classical shock index (SI), modified shock index (MSI), and age shock index (age SI) for predicting critical patients presenting to the emergency department (ED) with gastrointestinal bleeding (GIS). ⋯ In patients with GIS bleeding, age SI, which can be easily calculated in triage, is more significant than SI and MSI for predicting the critical patient.