The American journal of emergency medicine
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Observational Study
The LIMIT-NI clinical decision instrument reduces neuroimaging compared to unstructured clinician judgement in recurrent seizure patients.
The LIMIT clinical decision instrument (CDI) was published in 2021 to safely reduce neuroimaging in patients with recurrent seizures. The LIMIT CDI had a sensitivity of 90%, negative predictive value of >99.9%, and reduced neuroimaging by 13.3%. However, the design of the original LIMIT CDI made it cumbersome to use. The goal of this study was to validate the streamlined LIMIT-NeuroImaging (LIMIT-NI) CDI and compare its performance to the original LIMIT CDI. ⋯ The LIMIT-NI CDI demonstrated greater ease of application and improved test characteristics compared to the original LIMIT CDI. Compared to unstructured clinician judgement, the LIMIT-NI CDI reduced neuroimaging by 15.8% (relative reduction 40.2%) in recurrent seizure patients. The LIMIT-NI CDI can be used by physicians along with clinical judgement to reduce neuroimaging in the recurrent seizure patient.
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Catatonia is a poorly understood and underrecognized psychomotor condition characterized by three or more catatonic symptoms, commonly including abnormalities in speech, affect, and movement. Catatonia is generally associated with psychiatric disorders such as bipolar disorder and schizophrenia, but may be seen in general medical conditions and rarely after physical trauma. Here, we present the first pediatric case of catatonia following traumatic brain injury as well as the first case of catatonia in any patient following minor traumatic brain injury.
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Case Reports
A rare combination of methemoglobinemia and carboxyhemoglobinemia in pesticide poisoning.
Dyshemoglobinemias are disorders in which the haemoglobin is functionally altered and prevented from carrying oxygen. They include carboxyhemoglobin, methemoglobin, and sulfhemoglobin. This increase in abnormal haemoglobin has reduced oxygen binding capacity, which leads to decrease in total oxygen content in the blood causing anaemic-hypoxia. ⋯ The patient's signs and symptoms gradually reduced in a few days and got discharged after 2 weeks without any neurological and cardiorespiratory sequelae. An early suspicion and personalized emergency management was the key to success. As in all fields of Medicine, Emergency Medicine is also witnessing a change towards precision and personalized Medicine practice.