The American journal of emergency medicine
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Current literature contains an extensive number of analyses on the diagnostic value and utilization of the direct rectal exam in trauma patients. Presently, ATLS recommends the application of the digital rectal exam in trauma patients following a primary assessment of traumatic injuries. We aim to assess the validity and diagnostic value of the digital rectal exam in trauma populations. ⋯ The use of digital rectal exams in trauma patients illustrates limited to no validity and reliability in assessing pertinent injuries and does not influence the management of injuries. Trauma societies should consider creating guidelines and algorithms to clarify the use of digital rectal exams in specific situations and injury types.
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Case Reports
Keep shocking: A case report of double sequential defibrillation for refractory ventricular fibrillation.
Double sequential defibrillation is proposed as a novel modality of managing refractory ventricular fibrillation (VF). However, existing evidence has not been enough to support this. Here, we report an interesting case of a 54-year-old male who suffered from cardiac arrest with VF rhythm. ⋯ He had another episode of VF unresponsive to thirty minutes of standard defibrillation on his way to the catheterization laboratory. Again, the VF was terminated by double sequential defibrillation. Five days later, the patient was discharged home without neurological sequels.
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Randomized Controlled Trial
Clinical predictors of endotracheal intubation in patients presenting to the emergency department with angioedema.
The objective of this study is to identify predictors of airway compromise among patients presenting to the emergency department with angioedema in order to develop and validate a risk score to augment clinician gestalt regarding need for intubation. ⋯ A simple scoring algorithm may aid in predicting angioedema patients at high and low risk for intubation. External validation of this score is necessary before wide-spread adoption of this decision aid.
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This study aims to investigate the diagnostic value of End-tidal carbon dioxide (ETCO2) measured non-invasively at the bedside in order to distinguish between unstable angina pectoris (UAP) and non-cardiac chest pain among patients who present to the emergency department with chest pain without a history of cardiac pathology. ⋯ ETCO2, a non-invasive parameter that can be measured immediately at the bedside, may be proposed as a potential biomarker for differentiating patients with UAP from those with non-cardiac chest pain.