The American journal of emergency medicine
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Multicenter Study Observational Study
Are serial neuron-specific enolase levels associated with neurologic outcome of ECPR patients: A retrospective multicenter observational study.
This study aims to evaluate whether neuron-specific enolase (NSE) level at 48 h after extracorporeal cardiopulmonary resuscitation (ECPR) is associated with neurologic outcomes at 6 months after hospital discharge. ⋯ NSE level at 72 h displayed the highest association with neurologic outcome after ECPR, and NSE level at 48 h was also associated with neurologic outcome after ECPR.
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Thyroid storm is a rare but serious condition that carries a high rate of morbidity and even mortality. ⋯ An understanding of thyroid storm can assist emergency clinicians in diagnosing and managing this potentially deadly disease.
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The HEART score for risk stratifying chest pain patients in the emergency department (ED) has been widely adopted in clinical practice, but is often employed with nonconformant serial troponin measurements. ⋯ Our data suggest serial measurement of conventional troponin provides limited added benefit in low risk HEART score patients, regardless of duration and timing of symptoms. Conversely, serial troponin measurement may confer utility in moderate/high risk HEART score patients, particularly those presenting within 3 h of symptoms.
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Individuals experiencing intimate partner violence (IPV) and/or human trafficking (HT) are at increased risk of severe health consequences as a result of legislation criminalizing and/or restricting abortion, which is expected to increase as a result of the Supreme Court decision Dobbs v. Jackson. These risks are further stratified by race, socioeconomics, and other marginalizing demographic attributes. ⋯ This is particularly relevant to individuals experiencing IPV and HT, as they may be more likely to use these methods for obtaining an abortion due to numerous barriers. Emergency medicine clinicians are vital in providing care to these patients, as they frequently present to emergency departments. A multi-pronged approach to better support these patients is essential, involving an increased index of suspicion for IPV, HT or the complications of unsupervised abortion, improved organizational structures, specialized training for staff, improved screening methods, reflection on implicit bias, and recommendations for mindful documentation and legal considerations.
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When weighing the costs and benefits of "choosing wisely," in a healthcare climate that continues to stress cost-saving practices, it is difficult to argue with approaching low-risk patients with conservative approaches and treatments. In defense of liberal and broad approaches to patient workups, however, one must also weigh the bounce-back emergency department (ED) visit, which may represent either a failure of initial evaluation or a success of appropriate return precautions. ⋯ Magnetic Resonance Imaging (MRI) of the brain and spine demonstrated extensive and multifocal areas of signal abnormalities consistent with active demyelination concerning for acute disseminated encephalomyelitis (ADEM). Additional lab workup demonstrated seropositive myelin oligodendrocyte glycoprotein (MOG) antibodies, further supporting the diagnosis of ADEM, an immune-mediated disorder which can lead to rapid multifocal neurologic dysfunction.