Can J Emerg Med
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In emergency department patients with symptoms suggestive of acute myocardial infarction, is the absolute or relative change of cardiac troponin assays (either high sensitivity or ultrasenstive) more accurate in diagnosing acute myocardial infarction at 1 to 2 hours postpresentation? ⋯ To evaluate the accuracy of new troponin assays in diagnosing acute myocardial events.
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To evaluate the efficacy and safety of a simple linear midazolam-based protocol for the management of impending status epilepticus in children up to 18 years of age. ⋯ This simple linear protocol is an effective and safe regimen for the treatment of impending status epilepticus in children.
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Case Reports
Streptococcus pneumoniae-induced purpura fulminans in a woman with functional asplenia.
Purpura fulminans is a rare complication of septic shock, often associated with Streptococcus pneumoniae. Patients with anatomic or functional asplenia are at increased risk for infection because of impairment of their ability to defend against encapsulated pathogens. ⋯ The clinical presentation, diagnosis, and management of purpura fulminans are reviewed. Purpura fulminans is a rare condition that requires early diagnosis and aggressive management by emergency physicians.
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Observational Study
Drowning: an overlooked cause of out-of-hospital cardiac arrest in Canada.
Drowning is a major public health concern, yet little is known about the characteristics of drowning patients. The objectives of this study were to describe the demographic and clinical characteristics of out-of-hospital cardiac arrest (OHCA) attributed to drowning in Ontario and to compare the characteristics of OHCA attributed to drowning to those of presumed cardiac etiology. ⋯ Significant differences exist between OHCA of drowning and presumed cardiac etiologies. Most drownings are unwitnessed, occur in public locations, and present with nonshockable initial rhythms, suggesting that treatment should focus on bystander CPR. Future initiatives should focus on strategies to improve supervision in targeted locations and greater emphasis on bystander-initiated CPR, both of which may reduce drowning mortality.