The American journal of emergency medicine
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Comparative Study
ED length-of-stay and illness severity in dizzy and chest-pain patients.
Emergency department (ED) length of stay, illness severity, and patterns of ED-based testing can be used to compare different ED patient populations. To assess the relative significance of ED patients with dizziness and chest pain in emergency medicine practice, the investigators formed a retrospective chart review of 3,864 adults (age > or = 16 years) seen at the University of North Carolina Hospitals' ED during May and June of 1991. Patients were eligible if they had any complaint of dizziness (n = 259), nontraumatic chest pain (n = 168), or both (n = 18). ⋯ Chest-pain patients were more likely to undergo electrocardiogram and x-ray testing, whereas dizzy patients more often received testing such as brain computed tomography scanning (10.8% v 3.6%, P = .01). ED patients with dizziness and chest pain were similar with regard to ED length of stay. Given their overall similarities to the chest-pain group, dizzy patients appear to represent a significant population of ED patients and may warrant more clinical study.
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The case of a 57-year-old male athlete who developed acute hyponatremia during participation in a 100 mile ultra-marathon is discussed. The initial presentation was one of rapid neurological deterioration and transient cardiovascular instability. ⋯ With increasing interest in ultra-endurance events, the incidence of acute hyponatremia may increase. It is important that emergency physicians recognize this phenomenon and be familiar with the principles of acute intervention.
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Cocaine and ethanol abuse remains a major problem in our society. The active metabolite of the co-ingestion of cocaine and ethanol, cocaethylene, has been reported recently. This active and potentially toxic metabolite has enormous implications for emergency physicians. This article is a brief review of the current understanding of cocaethylene and its role as a serious toxin in the practice of emergency medicine.
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Selective necrosis and degeneration of the globus pallidus are characteristic autopsy findings in patients with severe carbon monoxide (CO) poisoning. The objective of this study was to show that computed tomography (CT) may demonstrate these morphological changes in the brain during life, and provide a clue to prognosis. The authors reviewed the medical records of 19 consecutive patients with acute CO poisoning who underwent CT examination during hospitalization. ⋯ Of the 10 patients with abnormal CT scans, 9 survived to hospital discharge but all had some degree of functional neurological impairment. Eighty-nine percent (8 of 9) of the patients with normal CT scans were discharged neurologically intact. Awareness of the potential for basal ganglia lesions in CO poisoning should lead to more accurate CT interpretation and may have significant prognostic implications.
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Letter Case Reports
Emergent femoral vein cannulation: report of a serious and unusual complication.