The American journal of emergency medicine
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Multicenter Study Clinical Trial
Combined copeptin and troponin to rule out myocardial infarction in patients with chest pain and a history of coronary artery disease.
The main objective of this multicentric study was to evaluate the additional value of copeptin to conventional cardiac troponin (cTn) for a rapid ruling out of acute myocardial infarction (AMI) in patients with acute chest pain and a previous history of coronary artery disease (CAD). ⋯ In triage patients with acute chest pain lasting for less than 6 hours and a previous history of CAD, the combination of copeptin and cTn allows for the ruling out AMI, with a negative predictive value greater than 95%.
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Early aggressive resuscitation in patients with severe sepsis decreases mortality but requires extensive time and resources. This study analyzes if patients with sepsis admitted through the emergency department (ED) have lower inpatient mortality than do patients admitted directly to the hospital. ⋯ Admission for sepsis through the ED was associated with lower early and overall inpatient mortality in this large national sample.
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Comparative Study
The diagnostic accuracy of an abdominal radiograph with signs and symptoms of intussusception.
The objective of this study was to compare the diagnostic accuracy of an abdominal ultrasound to that of a highly suggestive abdominal radiograph combined with signs and symptoms of intussusception. ⋯ Ultrasound is not needed before an enema for the diagnosis of intussusception for those with a highly suggestive abdominal radiograph, abdominal pain, lethargy, and vomiting.
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The aim of this study was to define the nature of metabolic acidosis in patients with septic shock on admission to intensive care unit (ICU) using Stewart method. We also aimed to compare the ability of standard base excess (SBE), anion gap (AG), and corrected AG for albumin and lactate (AGcorr) to accurately predict the presence of unmeasured anions (UA). ⋯ Patients with septic shock exhibit a complex metabolic acidosis at ICU admission. High UA may be present with normal values of SBE and [HCO3-] as a result of associated "relative" hypochloremic alkalosis. Corrected AG for albumin and lactate offers the most accurate bedside alternative to Stewart calculation of UA.
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Evaluation of rates of spontaneous abortion (SAB) may aid in counseling pregnant patients seen in the emergency department (ED). A recent chart review reported an SAB rate of 10% among ED patients with a documented intrauterine pregnancy (IUP) and cardiac activity on ultrasound. We sought to prospectively evaluate outcomes among pregnant ED patients with documented cardiac activity on ultrasound. ⋯ In this study, which represents the first prospective evaluation of ED patients with documented IUP with fetal heart tones, the rate of SAB was consistent with that reported previously for this population. These results confirm that ED patients represent a high-risk group, and additional research is needed to better characterize risk factors for SAB.