The American journal of emergency medicine
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Comparative Study Clinical Trial
Comparing diagnostic accuracy of bedside ultrasound and radiography for bone fracture screening in multiple trauma patients at the ED.
Long bone fractures are currently diagnosed using radiography, but radiography has some disadvantages (radiation and being time consuming). The present study compared the diagnostic accuracy of bedside ultrasound and radiography in multiple trauma patients at the emergency department (ED). ⋯ Bedside ultrasound is not a reliable method for diagnosing fractures of upper and lower limb bones compared with radiography.
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The earliest definition of transfusion-related acute lung injury (TRALI) included all patients who developed acute respiratory distress, moderate to severe hypoxemia, rapid onset of pulmonary edema, mild to moderate hypotension, and fever within 6 hours of receiving a plasma containing blood transfusion. The definition excluded patients if they had underlying cardiac or respiratory disease. The mechanism is not known exactly but it causes morbidity and mortality. ⋯ A 78 year old female patient with history of myelodysplastic syndrome, coronary artey disease and hypertansion, was admitted to the hospital because of dyspnea after the blood transfusion. She was managed as TRALI after diagnostic workup and transported to the intensive care unit. In the following days her clinical status changed dramatically with complete recovery.
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Four to ten percent of patients evaluated in emergency departments (ED) present with altered mental status (AMS). The prevalence of non-convulsive seizure (NCS) and other electroencephalographic (EEG) abnormalities in this population is unknown. ⋯ The prevalence of EEG abnormalities in ED patients with undifferentiated AMS is significant. ED physicians should consider EEG in the evaluation of patients with AMS and a high suspicion of NCS/NCSE.
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Case Reports
Spontaneous septic arthritis in a patient without trauma, coinfection, or immunosuppression.
Septic arthritis is a rare infection, most often affecting the knee and hip [1]. Infections are often secondary to joint repair or replacement surgery, systemic infection, or intravenous recreational drug use [1,2]. ⋯ Although septic arthritis can occur spontaneously, such occurrences are rare. We report a case of a previously healthy 54-year-old woman with no known risk factors presenting to a freestanding emergency department with 5 days of shoulder pain.
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Patients with suspected acute aortic syndromes (AAS) often undergo computed tomography (CT) with negative results. We sought clinical and diagnostic criteria to identify low-risk patients, an initial step in developing a clinical decision rule. ⋯ Our results demonstrate a need to safely identify patients at low risk for AAS who can forgo CT. We developed a preliminary 2-step clinical decision rule, which requires validation.