The American journal of emergency medicine
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Review
Ultrasound for the diagnosis of necrotizing fasciitis: A systematic review of the literature.
Necrotizing fasciitis (NF) is a deadly disorder that can be challenging to diagnose on history and examination alone. Point-of-care ultrasound (POCUS) is widely available and has been increasingly used for diagnosing skin and soft tissue infections. We performed a systematic review to determine the accuracy of POCUS for diagnosing NF with subgroup analyses of the accuracy of specific POCUS examination components. ⋯ POCUS has good sensitivity and specificity for the diagnosis of NF. POCUS should be considered as an adjunct to the initial clinical decision making for the diagnosis of NF.
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Mesenteric ischemia is a rare, frequently misdiagnosed, serious condition that carries with it a high rate of morbidity and mortality. ⋯ An understanding of mesenteric ischemia can assist emergency clinicians in diagnosing and managing this disease.
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Review
A brief review of the diagnosis and management of arrhythmogenic right ventricular cardiomyopathy.
Arrhythmogenic right ventricular cardiomyopathy (ARVC) is a genetic disorder of the myocardium that can lead to ventricular arrhythmia and sudden cardiac death. The condition has been identified as a significant cause of arrhythmic death among young people and athletes, therefore, early recognition of the disease by emergency clinicians is critical to prevent subsequent death. The diagnosis of ARVC can be very challenging and requires a systematic approach. This publication reviews the pathophysiology, classification, clinical presentations, and appropriate approach to diagnosis and management of ARVC.
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Randomized Controlled Trial
Association between rate of change in PaCO2 and functional outcome for patients with hypercapnia after out-of-hospital cardiac arrest: Secondary analysis of a randomized clinical trial.
Normocapnia is suggested for post resuscitation care. For patients with hypercapnia after cardiac arrest, the relationship between rate of change in partial pressure of carbon dioxide (PaCO2) and functional outcome was unknown. ⋯ For OHCA patients with hypercapnia on admission, the rate of change in PaCO2 was not independently associated with functional outcome; however, there was a significant trend that higher decreased rate was associated with increased hospital mortality.
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The role of basic life support (BLS) vs. advanced life support (ALS) in pediatric trauma is controversial. Although ALS is widely accepted as the gold standard, previous studies have found no advantage of ALS over BLS care in adult trauma. The objective of this study was to evaluate whether ALS transport confers a survival advantage over BLS among severely injured children. ⋯ Among severely injured children, prehospital ALS care was not associated with lower mortality rates relative to BLS care. Because of potential confounding by severity in this retrospective analysis, further studies are warranted to validate these results.