The American journal of emergency medicine
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Blast injury is a unique condition that carries a high rate of morbidity and mortality, often with mixed penetrating and blunt injuries. ⋯ An understanding of blast injuries can assist emergency clinicians in diagnosing and managing this potentially deadly disease.
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Spontaneous bacterial peritonitis (SBP) is a common infection in patients with cirrhosis and ascites and is associated with significant risk of mortality. Therefore, it is important for emergency medicine clinicians to be aware of the current evidence regarding the diagnosis and management of this condition. ⋯ An understanding of literature updates can improve the care of patients with suspected SBP.
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We present a case of cardiopulmonary arrest secondary to rivaroxaban related oropharyngeal hemorrhage, which required rapid intravenous (IV) push administration of 4-factor prothrombin complex concentrate (4F-PCC). Manufacturers recommend administering 4F-PCC IV at a rate of 0.12 mL/kg/min (approximately 3 units/kg/min) up to a maximum rate of 8.4 mL/min (approximately 210 units/min) [1]. The concern with rapid administration is increased potential for thromboembolic complications. ⋯ Bleeding was controlled enough to secure the patient's airway within 5 min after 4F-PCC administration and subsequently return of spontaneous circulation was achieved. Unfortunately, the patient suffered a poor neurologic outcome and the family withdrew care after discussion with the treatment team and the patient's oncologist. This case report demonstrates rapid administration of 4F-PCC may be an effective intervention to treat immediately life threatening rivaroxaban related bleeding.
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Observational Study
Comparison of artificial intelligence versus real-time physician assessment of pulmonary edema with lung ultrasound.
Lung ultrasound can evaluate for pulmonary edema, but data suggest moderate inter-rater reliability among users. Artificial intelligence (AI) has been proposed as a model to increase the accuracy of B line interpretation. Early data suggest a benefit among more novice users, but data are limited among average residency-trained physicians. The objective of this study was to compare the accuracy of AI versus real-time physician assessment for B lines. ⋯ Both the physician and AI software were highly sensitive, though the physician was more specific. Future research should identify which factors are associated with increased diagnostic accuracy.
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Observational Study
Establishing a rapid assessment service for patients with suspected malignancies for expedited outpatient management.
11% of new cancer diagnoses occur in the emergency department. Historically, these diagnoses disproportionately affect underserved patient populations and are associated with poor outcomes. This is an observational study of the Rapid Assessment Service (RAS) program, which aims to provide timely outpatient follow-up and facilitate a diagnosis for patients discharged from the emergency department with suspected malignancies. ⋯ Creating a Rapid Assessment Service facilitated an expedited oncologic work-up and diagnosis in an outpatient setting.