J Emerg Med
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Case Reports
Successful computed tomography angiogram through tibial intraosseous access: a case report.
Intraosseous access has been used increasingly with proven efficacy in emergent situations for adults when intravenous access could not be obtained. ⋯ The pulmonary arteries were opacified and demonstrated a high-quality CT angiogram can be done via tibial IO device.
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Among patients who die from pulmonary embolus (PE), approximately two-thirds succumb within an hour of presentation. Computed tomography can provide a definitive diagnosis but is associated with practical limitations. Echocardiography can increase diagnostic certainty of PE by visualizing signs of acute right ventricular (RV) strain. This case highlights a potentially lethal finding associated with PE and the role of clinician-performed bedside echocardiography in the timely management of this disease. ⋯ The clinician performed a focused echocardiogram to evaluate the cause of the patient's critical state. PE-in-transit, a rare entity associated with large PEs, was identified, which obviated the need for further diagnostic evaluation and led to immediate aggressive therapy. Increased familiarity with the uses of bedside sonography in the evaluation of shock and respiratory distress may allow clinicians to become more proficient in managing these patients.
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Coronary computed tomography angiography (CCTA) can be used for low-risk chest pain patients, but presents a risk of contrast-induced nephropathy. ⋯ The choice of SCr or GFR to screen patients for CCTA selectively excludes either males or females, respectively. Therefore, individual physicians and institutions must understand the impact of both renal function tests and cutoff points when identifying patients who may be eligible for CCTA.
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There exists a significant amount of misinformation regarding methadone and buprenorphine, and a belief that toxicity associated with nonmedical use of methadone and nonmedical use of buprenorphine is similar in severity and outcomes. ⋯ Patients who use methadone nonmedically have higher hospitalization rates, greater ICU utilization rates, and considerably worse medical outcomes when compared with patients who use buprenorphine nonmedically.
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Records of patients discharged from the Emergency Department (ED) who return within 72 h and are admitted are often reviewed for potential quality issues. ⋯ Poor care on the initial visit or any poor outcome upon returning in 72-h return admissions is relatively rare in the ED. Reporting 72-h return admissions without chart review may not be a good way to measure clinical quality.