The American journal of emergency medicine
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Early recognition of sepsis is essential for timely initiation of adequate care. However, this is challenging as signs and symptoms may be absent or nonspecific. The cascade of events leading to organ failure in sepsis is characterized by immune-metabolic alterations. Volatile organic compounds (VOCs) are metabolic byproducts released in expired air. We hypothesize that measuring the VOC profile using electronic nose technology (eNose) could improve early recognition of sepsis. ⋯ The study is embedded in the Acutelines data-biobank (www.acutelines.nl), registered in Clinicaltrials.gov (NCT04615065).
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We conducted an explanatory, sequential mixed-methods study to measure variation in the use of imaging and physical therapy (PT) for acute low back pain (LBP) and to identify implementation determinants that might explain variation in use across 22 EDs and 27 urgent cares in urban and rural locations within a community-based health system. ⋯ Guideline concordance for use of imaging and PT varied substantially across physicians and advance practice providers providing care at EDs and UC centers within a community-based health system. Implementation strategies that address barriers identified by this study, including varied understanding of the PT discipline, complex workflows for placing PT referrals, the medico-legal assurance that imaging provides, and the lack of feedback loops in ED and UC centers should be tested in future hybrid implementation-effectiveness trials to increase concordance to LBP guidelines and minimize harm related to overuse of imaging and underuse of conservative first-line treatment approaches.
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Most injured children are initially seen at non-pediatric hospitals, then transferred to a pediatric trauma center for definitive care. Published outcomes of transferred children with blunt abdominal trauma (BAT) are sparse. Our objective is to describe this population and their disposition at a pediatric trauma center. ⋯ Compared to those with positive CTa/p at OSF, children who had positive CTa/p at PTC were younger, had higher ISS scores, and longer LOS, suggesting they were more seriously injured. Children with BAT and negative CTa/p in absence of other injuries, may not require transfer to a PTC. Enhanced understanding of these patients may reduce unnecessary transfers, improving resource utilization.
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Capivasertib is a new targeted therapy for the treatment of select cases of hormone receptor positive, HER2 negative advanced breast cancer. Hyperglycemia is a known adverse effect of capivasertib with a 16 % incidence rate, however life-threatening hyperglycemia occurs rarely (incidence 0.3 %). We describe a case of severe hyperglycemic hyperosmolar syndrome with serum blood glucose of 1558 mg/dL in an 86 year old female patient presenting to the emergency department 16 days after starting oral capivasertib. ⋯ Her initial presentation was complicated by altered mental status, hypothermia, hypotension, and bradycardia, and she required over a week of intensive care. This case highlights the need for awareness of acute, severe hyperglycemia as a potential adverse effect of capivasertib and similar oncologic agents. Clinicians should ensure at least twice weekly blood glucose monitoring for any degree of capivasertib-induced hyperglycemia, and have high suspicion for this contributing factor in cases of severe hyperglycemia.
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Gastroduodenal intussusception is a rare but important cause of gastric outlet obstruction, particularly in elderly patients. We present the case of an 81-year-old female who arrived at the emergency department with complaints of epigastric pain, nausea, and vomiting. A CT scan revealed gastroduodenal intussusception, while subsequent endoscopy identified a submucosal mass, raising suspicion for either a gastrointestinal stromal tumor (GIST) or pancreatic rest. This case report highlights the diagnostic process, therapeutic considerations, and clinical outcomes, with a review of the relevant literature.