The American journal of emergency medicine
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Subjects with chest pain and a negative diagnostic workup constitute a problem for emergency physicians. We tested the usefulness of clinical variables in predicting 30-day and 6-month outcome in subjects with chest pain of undifferentiated origin after a negative workup. ⋯ In subjects with chest pain of undifferentiated origin, the risk of unfavorable outcome cannot be accurately predicted by the selected clinical items.
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Case Reports
HIV-positive patient with herpes zoster: a manifestation of the immune reconstitution inflammatory syndrome.
Herpes zoster is a common illness that can lead to serious morbidity. There is now evidence that HIV-infected patients who have been treated with antiretroviral therapy are at greater risk of developing herpes zoster not when they are severely immunocompromised but, paradoxically, when their immune system is recovering. This is a manifestation of the immune reconstitution inflammatory syndrome. ⋯ Emergency department physicians should be aware that HIV-infected patients treated with HAART may have clinical deterioration despite immune system strengthening. This immune reconstitution inflammatory syndrome can present with infectious, autoimmune, or oncological manifestations. Our case patient, an HIV-positive man with immune system recovery after treatment with HAART, presented with an infectious manifestation, herpes zoster.
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Case Reports
Life-threatening anaphylactoid shock caused by recombinant tissue plasminogen activator.
Recombinant tissue plasminogen activator (rt-PA) is currently the only approved agent for treating acute ischemic stroke. However, rt-PA may cause fatal symptomatic intracranial hemorrhage and other adverse effects like bleeding complications and allergic reactions. ⋯ This report is about a patient with a history of ACE inhibitor intake who experienced life-threatening anaphylactoid shock during rt-PA administration. The relationship between rt-PA and ACE inhibitor was also discussed.
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Although pocket-sized, simplified ultrasound devices have emerged to enable subjective point-of-care assessment, few data on their cardiac application exist. We sought to examine the image quality and the accuracy of subjective diagnosis of video loops obtained from a pocket-sized ultrasound device for 2 significant cardiac abnormalities, left ventricular systolic dysfunction and left atrial enlargement, obtained from a single, quick-look view. ⋯ The pocket-sized device provided adequate imaging for screening of 2 significant cardiac entities. Subjective interpretation of a single parasternal view may help identify patients with cardiac disease.
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The study aimed to estimate the prevalence of need for dental care among patients in the ED and assess associated characteristics. ⋯ Of the patients presenting to the ED, 40.6% were in some need of dental care. This need was not associated with insurance or socioeconomic status as shown in previous studies. Age, ethnicity, and no routine oral care in the last 3 years were all associated with early/urgent need for oral health care.