Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
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Observational studies of patients with cocaine-associated myocardial infarction have suggested more coronary disease than expected on the basis of patient age. The study objective was to determine whether cocaine use is associated with coronary disease in low- to intermediate-risk emergency department (ED) patients with potential acute coronary syndrome (ACS). ⋯ In symptomatic ED patients at low to intermediate risk of an ACS, cocaine use was not associated with an increased likelihood of coronary disease after adjustment for age, race, sex, and other risk factors for coronary disease.
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Computed tomography angiograms (CTAs) for patients with suspected pulmonary embolism (PE) are being ordered with increasing frequency from the emergency department (ED). Strategies are needed to safely decrease the utilization of CTs to control rising health care costs and minimize the associated risks of anaphylaxis, contrast-induced nephropathy, and radiation-induced carcinogenesis. The use of compression ultrasonography (US) to identify deep vein thromboses (DVTs) in hemodynamically stable patients with signs and symptoms suggestive of PE is highly specific for the diagnosis of PE and may represent a cost-effective alternative to CT imaging. ⋯ A selective CT strategy using compression US is cost-effective for patients provided they have a high pretest probability of PE. This may reduce the need for, and decrease the adverse events associated with, CTAs.
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The patient with epidural hematoma and cerebral herniation has a good prognosis with immediate drainage, but a poor prognosis with delay to decompression. Such patients who present to nonneurosurgical hospitals are commonly transferred without drainage to the nearest neurosurgical center. This practice has never been demonstrated to be the safest approach to treating these patients. A significant minority of emergency physicians (EPs) have advised and taught bedside burr hole drainage or skull trephination before transfer for herniating patients. The objective of this study was to assess the effect of nonneurosurgeon drainage on neurologic outcome in patients with cerebral herniation from epidural hematoma. ⋯ Although the total number of patients is small and the population highly selected, the natural history of cerebral herniation from epidural hematoma and the best available evidence suggests that herniating patients have improved outcomes with drainage procedures before transport.
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Comparative Study
The treatment of pediatric gastroenteritis: a comparative analysis of pediatric emergency physicians' practice patterns.
Acute gastroenteritis is a very common emergency department (ED) diagnosis accounting for greater than 1.5 million outpatient visits and 200,000 hospitalizations annually among children in the United States. Although guidelines exist to assist clinicians, they do not clearly address topics for which evidence is new or limited, including the use of antiemetic agents, probiotics, and intravenous (IV) fluid rehydration regimens. This study sought to describe the ED treatments administered to children with acute gastroenteritis and to compare management between Canadian and U.S. physicians practicing pediatric emergency medicine (PEM). ⋯ The treatment of pediatric gastroenteritis varies by geographic location and differs significantly between Canadian and American PEM physicians. Oral rehydration continues to be underused, particularly in the United States. Probiotic use remains uncommon, while ondansetron administration has become routine. Children frequently receive IV rehydration, with the rate and volume administered being greater in the United States.