The American journal of emergency medicine
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Multicenter Study
Prognostic significance of nadir platelet count in patients with heatstroke: A multi-center retrospective study.
Heatstroke (HS), associated with the early activation of the coagulation system and frequently presenting with thrombocytopenia, poses a significant healthcare challenge. Understanding the relationship of nadir platelet count (PLT) within 24 h for adverse outcomes in HS patients is crucial for optimizing management strategies. ⋯ Nadir PLT within 24 h were tied to in-hospital mortality and various adverse outcomes in HS patients. Early effective cooling measures demonstrated a positive impact on these associations, underscoring their importance in patient management.
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Comparative Study
Predicting severe outcomes in pediatric trauma patients: Shock index pediatric age-adjusted vs. age-adjusted tachycardia.
When an injured patient arrives in the Emergency Department (ED), timely and appropriate care is crucial. Shock Index Pediatric Age-Adjusted (SIPA) has been shown to accurately identify pediatric patients in need of emergency interventions. However, no study has evaluated SIPA against age-adjusted tachycardia (AT). This study aims to compare SIPA with AT in predicting outcomes such as mortality, severe injury, and the need for emergent intervention in pediatric trauma patients. ⋯ AT outperforms SIPA in sensitivity for mortality, injury severity and emergent interventions in pediatric trauma patients while the specificity of SIPA is high across these outcomes.
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Boarding time in the Emergency Department (ED) is an area of concern for all patients and potentially more problematic for the hip fracture population. Identifying patient outcomes impacted by ED boarding and improving emergent care to reduce surgical delay for this patient population is a recognized opportunity. The objective of this study is to examine the impact of ED boarding in relation to patient outcomes in the surgical hip fracture population. ⋯ In contrast to the existing literature, ED boarding in our study was not associated with adverse outcomes except for time to surgery. By expediting the time to surgery in accordance with established guidelines, adverse outcomes were mitigated even when our patients boarded for a longer duration. System processes including a 24/7 trauma nurse practitioner model, availability of in-house orthopedic surgeons, and timely cardiac evaluation need to be considered in relation to time to surgery, in turn impacting ED boarding and patient outcomes.
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Observational Study
Lactate-to-albumin ratio and cholesterol levels predict neurological outcome in cardiac arrest survivors.
Out-of-hospital cardiac arrest (OHCA) increases lactate levels and reduces albumin levels on admission and tends to lead to a poor neurological prognosis. In our experience, reduced cholesterol levels predict poor neurological prognosis. However, the relationship between cholesterol levels and neurological prognosis in OHCA survivors remains unclear. ⋯ The LAR, albumin, total cholesterol, and HDL-cholesterol levels measured on admission may predict neurological prognosis in OHCA survivors. Thus, routine practice should include the measurement of these biomarkers at 6 h after resuscitation, especially in patients with a lactate level of > 5 mmol/L.
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Case Reports
Unusual presentation of spontaneous ruptured hepatocellular carcinoma: Inguinal hernia.
Spontaneous ruptured hepatocellular carcinoma (HCC) remains a life-threatening condition despite improvements in diagnostic methods and established treatment strategies. Although typical clinical presentations of spontaneous ruptured HCC facilitate easy diagnosis, this condition can present with unexpectedly varied symptoms, making diagnosis challenging. We describe an atypical clinical presentation of spontaneous ruptured HCC mimicking an inguinal hernia. ⋯ Spontaneous ruptured HCC can potentially mimic other abdominal conditions such as an inguinal hernia, even in cases of undiagnosed liver cirrhosis. Although unenhanced CT can reveal bloody ascites suggesting hemoperitoneum, the underlying cause should be carefully considered. Emergency physicians should recognize various clinical presentations of spontaneous ruptured HCC to ensure prompt diagnosis and treatment of this potentially fatal complication.