The American journal of emergency medicine
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Case Reports
Successful treatment of thyroid crisis accompanied by hypoglycemia, lactic acidosis, and multiple organ failure.
We describe a case of thyroid crisis with hypoglycemia, lactic acidosis, multiple organ failure, and disseminated intravascular coagulation--rare but severe complications of thyroid crisis. The patient was a 59-year-old Chinese woman who presented with evidence of heart failure and atrial fibrillation. Analysis of a blood sample yielded astonishing results: her blood glucose was 1.7 mmol/L, and lactate greater than 15 mmol/L with the arterial pH as 6.94. ⋯ Prompt treatments such as mechanical ventilation, plasma exchange, and continuous venovenous hemofiltration were preformed, along with antithyroid medication. The patient finally survived after 3 weeks of intensive care. We herein discuss the possible mechanisms of these metabolic disorders in thyroid crisis and possible therapeutic measures that could be used to reduce mortality.
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Case Reports
Blood-fluid level on computed tomography head: a sign of warfarin-associated intraparenchymal hemorrhage.
“Blood/fluid level” represents interface between the plasma and sedimented blood and is defined radiologically as presence of area of low computed tomography (CT) attenuation above and high CT attenuation below a discrete line of separation in an area of intraparenchymal hemorrhage. It is a rare finding seen in association with large clot volume of intraparenchymal hemorrhage. We present a case of warfarin-related intraparenchymal hemorrhage presenting with a classic sign of “blood/fluid level” on CT head with small clot volume.
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The Bayesian approach to disease diagnosis in the emergency department is facilitated by the use of likelihood ratios (LRs) to evaluate diagnostic tests. The use of dichotomous, interval, and joint LRs for single and multiple tests is reviewed, and comparison is made to regression modeling. The clinical motivation for a single statistic to describe the average change in the odds of disease associated with the use of a particular test or series of tests is described. ⋯ Application of both tests together to patients with wide QRS complex tachycardia changes the odds of ventricular tachycardia, on average, by a factor of 3.5 (95% confidence interval, 2.4-6.2). Challenges are described, and methods are provided to estimate the 95% confidence interval of the LR and AALR using bootstrapping techniques. The AALR is a test statistic that may be helpful for clinicians and researchers in evaluating and comparing diagnostic testing approaches.
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Multicenter Study
Predictors of patient length of stay in 9 emergency departments.
Prolonged emergency department (ED) length of stay (LOS) is linked to adverse outcomes, decreased patient satisfaction, and ED crowding. This multicenter study identified factors associated with increased LOS. ⋯ Length of stay was increased on days with higher percentage daily admissions, higher elopements, higher periods of ambulance diversion, and during weekdays, whereas LOS was decreased on days with higher numbers of discharges and weekends. This is the first study to demonstrate this association across a broad group of hospitals.
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Myelography has been of great use as a diagnostic modality, especially when other modalities were not conclusive. However, considering the invasive nature of myelography, it should receive the attention of medical personnel for them to be aware of its possible complications, especially when newer agents are applied as the contrast media. ⋯ These complications include lower-extremity myoclonic spasms, tonic seizure leading to status epilepticus, rhabdomyolysis, disseminated intravascular coagulation and anaphylactic shock. Having the knowledge of possible complications and available solutions, particularly fatal ones, could prepare medical staff beforehand for primary and secondary preventions.