The American journal of emergency medicine
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Prompt recognition of electrocardiographic signs of acute coronary occlusion is essential for timely restoration of flow. ST-segment elevation or new onset left bundle-branch block are the most common electrocardiographic changes seen in acute phase of coronary occlusion. However, some patients may present with atypical electrocardiographic signs, and early diagnosis of these patients may constitute a clinical challenge. Here, we report a 41-year-old man presenting with an atypical electrocardiographic manifestation despite angiographically confirmed acute thrombotic occlusion of proximal left anterior descending artery.
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Jolt accentuation or exacerbation of a baseline headache with horizontal rotation of the neck is a physical finding believed to assess for meningeal irritation. We conducted a prospective observational study of neurologically intact emergency department (ED) patients undergoing lumbar puncture in 2 inner city academic EDs to validate the sensitivity and specificity of jolt accentuation and to assess the sensitivity and specificity of Kernig sign, Brudzinski sign, and nuchal rigidity, in predicting cerebrospinal fluid (CSF) pleocytosis in individuals being assessed for meningitis. Adult patients 18 years and older undergoing lumbar puncture between 2006 and 2009 were approached for consent. ⋯ The specificity of jolt accentuation was 82%, Kernig sign was 97%, Brudzinski sign was 98%, and nuchal rigidity was 80%. Jolt accentuation in our cohort was poorly predictive of pleocytosis and insensitive. The presence of Kernig sign, Brudzinski sign, or nuchal rigidity has moderate positive but no negative predictive value for pleocytosis.
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We assessed out-of-hospital cardiac arrest patients' cerebral oxygenation during cardiopulmonary resuscitation (CPR) using near infrared spectrophotometry (NIRS). We evaluated the relation between a rise in patients' cerebral saturation values between the start and end of CPR and return of spontaneous circulation. ⋯ Patients whose cerebral saturation values measured with NIRS rise during CPR have a higher post-resuscitation survival rate. Monitoring of patients during CPR with this non-invasive technique may be a good method for predicting return of spontaneous circulation.
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Clopidogrel is an adenosine diphosphate receptor antagonist. The risk of intracranial hemorrhage following minor head trauma in patients with pre-injury use of clopidogrel has not been fully determined. ⋯ The use of clopidogrel is associated with a significantly increased risk of developing intracranial hemorrhage following minor trauma.