Can J Emerg Med
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Comparative Study
Transient ischemic attack: management in the emergency department and impact of an outpatient neurovascular clinic.
1) To evaluate whether transient ischemic attack (TIA) management in emergency departments (EDs) of the Nova Scotia Capital District Health Authority followed Canadian Best Practice Recommendations, and 2) to assess the impact of being followed up in a dedicated outpatient neurovascular clinic. ⋯ The majority of patients in our study were treated with antithrombotic agents in the ED and investigated with CT and ECG within 24 hours; however, vascular imaging and neurovascular clinic follow-up were underutilized. For those with neurovascular clinic follow-up, there was an association with reduced risk of subsequent stroke, myocardial infarction, or vascular death.
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Patients with venous thromboembolism (VTE) (deep vein thrombosis [DVT] and pulmonary embolism [PE]) are commonly treated as outpatients. Traditionally, patients are anticoagulated with low-molecular-weight heparin (LMWH) and warfarin, resulting in return visits to the ED. The direct oral anticoagulant (DOAC) medications do not require therapeutic monitoring or repeat visits; however, they are more expensive. This study compared health costs, from the hospital and patient perspectives, between traditional versus DOAC therapy. ⋯ VTE management in the ED has opportunities for improvement. A DOAC is a viable and cost-effective strategy for VTE treatment from a hospital perspective and, depending on patient characteristics and values, may also be an appropriate and cost-effective option from a patient perspective.
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Case Reports
Bilateral Retinal Detachments Caused by Severe Preeclampsia Diagnosed with Point-of-Care Ultrasound.
Bilateral retinal detachments are a rare complication of preeclampsia. We present a case report of a patient with an unknown pregnancy who presented with acute bilateral vision loss and elevated blood pressure. Point-of-care ocular ultrasound revealed bilateral retinal detachments. She was diagnosed with severe preeclampsia and taken for an urgent caesarean section with the delivery of a 26-week-old infant.
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Lactate levels are increasingly used to guide resuscitation efforts. Some surgical literature suggests that tourniquet use during phlebotomy falsely elevates results, although studies in healthy volunteers have not demonstrated this. The purpose of this study was to determine in clinical practice whether tourniquet use during the drawing of a lactate results in significantly altered levels compared to the result of a level drawn without a tourniquet. ⋯ Tourniquet use appears to have no impact on measured lactate levels. Our findings suggest that current practices at many institutions regarding lactate collection are likely too stringent and should be changed.
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There is evidence to suggest that point-of-care ultrasound assessment of the lungs has a higher sensitivity and specificity than chest radiography for the diagnosis of pneumonia. It is unknown if the same is true for pneumonia complications. ⋯ An ultrasound of the patient's lungs was performed, and revealed a complex loculated fluid collection consistent with an empyema. A chest CT confirmed the diagnosis, and immediate percutaneous drainage was performed.