The American journal of emergency medicine
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The Electrocardiogram (ECG) is a readily available non-invasive test used in the evaluation of a patient with angina. ECG artifacts are common and stem from a number of different reasons including lead placement and must be identified to appropriately manage patients. We present the case of an elderly patient for whom an ECG was performed to evaluate chest pain showing an abnormal waveform concerning for an ST elevation myocardial infarction (STEMI). Closer inspection of the ECG revealed a characteristic pattern documented in the literature known as Aslanger's Sign seen when an ECG lead is placed over an artery.
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Although noise is known to negatively affect blood pressure (BP) measurements, its impact on different BP measurement methods remains unclear. The aim of this study is to compare the agreement of oscillometric and auscultatory BP measurement methods under in-ambulance noise levels. ⋯ The results of this study demonstrate that noise significantly affects the agreement between oscillometric and auscultatory blood pressure measurement methods.
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Tumor Lysis Syndrome (TLS) is a metabolic emergency seen in patients who receive cytotoxic chemotherapy and can result in significant morbidity and mortality, especially in those patients with high tumor burden. Spontaneous tumor lysis syndrome (STLS) occurs in patients without preceding chemotherapy but may occur in the setting of glucocorticoid administration. We present a case of a 75-year-old male with a history of myelodysplastic syndrome who presented with shortness of breath and developed acute renal failure due to tumor lysis syndrome, likely triggered by candidemia. To our knowledge, this is the first known case of STLS in a patient with high tumor burden who did not receive corticosteroids but likely developed this condition in the setting of infection.
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The rate of intravenous thrombolysis (IVT) utilization in acute ischemic stroke (AIS) has been increasing, and this has coincided with improved door-to-needle times (DNTs). Smaller hospitals have been observed to utilize IVT less frequently or even not at all. Using a multistate stroke registry, we sought to determine the impact of hospital size on trends in IVT utilization for AIS. ⋯ In our registry-based analysis, we observed an increased trend in IVT utilization for AIS among larger hospitals. There was an overall improvement in rates of DNTs ≤60 min, but only larger hospitals were observed to have improved DNTs ≤45 min.