The American journal of emergency medicine
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Lower leg weakness is a common and nonspecific complaint that encompasses a broad differential diagnosis at emergency department, which includes neurologic aspect and a wide range of nonneurologic conditions. Infective endocarditis usually presented with variable symptoms emphasizing constitutional complaints, or complaints that focus on primary cardiac effects or secondary embolic phenomena. ⋯ By far, it is rarely considered in the differential diagnosis of lower leg weakness. Herein, we present a case of a 56-year-old man who came to our emergency department with a chief concern of lower leg weakness, which was actually the result of L-spine osteomyelitis and spondylodiscitis as complications of infective endocarditis with septic emboli.
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It is unclear whether the prehospital termination of resuscitation (TOR) rule is applicable in specific situations such as in areas extremely dense with hospitals. ⋯ This study suggested that the prehospital TOR rule predicted unfavorable outcomes even in an area dense with hospitals in Tokyo and might be helpful for identifying the OHCA patients for whom resuscitation efforts would be fruitless.
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Randomized Controlled Trial
Stay and play eFAST or scoop and run eFAST? That is the question!
The concept that ultrasonography could be interesting in the prehospital setting and during the transfer of traumatized patients is not new. Paradoxically, there is a lack of description of routine use of ultrasonography in emergency ambulances. The aim of this study was to compare the feasibility and efficiency of an extended focused assessment sonography for trauma (eFAST) examination performed on-site, during the patient's transfer, or both. ⋯ The eFAST examination can provide reliable and important information in the initial evaluation of traumatized patients. It can be completed either on-site or during patient transfer. Its feasibility and efficiency are similar to that done in intensive units, especially if the examination is repeated.
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Most patients at low to intermediate risk for an acute coronary syndrome (ACS) receive a 12- to 24-hour "rule out." Recently, trials have found that a coronary computed tomographic angiography-based strategy is more efficient. If stress testing were performed within the same time frame as coronary computed tomographic angiography, the 2 strategies would be more similar. We tested the hypothesis that stress testing can safely be performed within several hours of presentation. ⋯ Patients who present to the ED with potential ACS can safely undergo a rapid diagnostic protocol with stress testing.
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Cardiac arrest is a daunting medical emergency. The aim of the present study was to assess whether the combination of adrenaline and glucagon would improve initial resuscitation success, 48-hour survival, and neurologic outcome compared with adrenaline alone in a porcine model of ventricular fibrillation. ⋯ In this porcine model of prolonged ventricular fibrillation, the addition of glucagon to adrenaline improves hemodynamics during resuscitation and early postresuscitation period and may increase survival.