J Emerg Med
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Atraumatic subarachnoid hemorrhage (SAH) is a deadly condition that most commonly presents as acute, severe headache. Controversy exists concerning evaluation of SAH based on the time from onset of symptoms, specifically if the headache occurred > 6 h prior to patient presentation. ⋯ The probability of SAH above which emergency clinicians should perform a lumbar puncture is 1.0%. This threshold is essentially the same as the estimated probability of SAH in patients with a negative head CT obtained more than 6 h from symptom onset. Emergency physicians might reasonably decide to either perform or forego this procedure. Consequently, we contend that the decision whether to perform lumbar puncture in these instances is an excellent candidate for shared decision-making.
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Multisystem inflammatory syndrome in children is a phenomenon that has emerged during the coronavirus disease 2019 (COVID-19) pandemic. There are, however, few reported cases of a similar disease in adults. ⋯ We describe a 25-year-old man who presented with prolonged fever and conjunctivitis and was found to have a post-COVID inflammatory syndrome. His symptoms improved with colchicine, steroids, and a truncated course of intravenous immunoglobulin. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Post-COVID inflammatory syndrome has the potential to lead to dangerous complications. In addition, the identification of occult COVID infections could have public health implications.
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Alcohol intoxication often affects patient management in the emergency department. ⋯ Both genders can estimate their impaired ability to drive while drinking, but women are better at assessing their capacity to drive after drinking cessation.
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Patients leaving the emergency department (ED) before treatment completion (LBTC) is a common universal occurrence. We hypothesized that the characteristics of the Israeli health care system, as well as its policy, intended to reduce the burden of nonurgent ED visits, may have an impact on factors associated with LBTC. ⋯ These findings reflect the strengths of the Israeli health care system. Despite the policy intended to reduce the burden of nonurgent ED visits, there are possible shortcomings in the system that should be addressed.
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The limitations of resuscitative thoracotomy (RT) after penetrating trauma have been well documented, but there is a paucity of data on the effect age has on mortality. This begs the question as to the utility of RT in an aging patient population. We investigate the significance of age as a predictor for failure to rescue after RT in penetrating trauma. ⋯ Age does not appear to be an independent predictor of failure to rescue after RT in penetrating trauma and should not be a sole determinant in procedural decision making.