J Emerg Med
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Observational Study
High-Dose Nitroglycerin Bolus for Sympathetic Crashing Acute Pulmonary Edema: A Prospective Observational Pilot Study.
Sympathetic crashing acute pulmonary edema (SCAPE) is a severe form of hypertensive acute heart failure with a dramatic presentation. Rapid identification and management in the emergency department (ED) is key to saving these patients and preventing morbidity associated with endotracheal intubation and intensive care treatment. Use of high-dose nitroglycerin (NTG) and noninvasive ventilation (NIV) has been advocated in management of such patients. ⋯ Use of our specific SCAPE treatment algorithm, which included high-dose NTG and NIV, was safe and provided rapid resolution of symptoms.
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Staffing and provider capacity are essential components of emergency department (ED) throughput. Patient flow is dependent on matching patient arrivals with provider capacity. Current models assume a static rate of patients per hour for providers; however, this metric has been shown to decrease throughout a shift in a pattern we describe as a staircase. ⋯ Academic EDs may find value in using a staircase model to analyze provider capacity because it is more reflective of actual capacity. EDs may benefit from visualizing their capacity curves to identify mismatches and staggering resident shifts to improve throughput and flow.
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Unenhanced computed tomography (CT) is a frequently used imaging method in patients who are evaluated in the emergency department with suspected cerebral vein thrombosis (CVT). ⋯ Hyperattenuation in the dural sinuses and the HU/Htc ratio in unenhanced brain CT scans have high diagnostic value in detecting CVT.
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Background Emergency medicine (EM) resident training in oncologic emergencies is limited, and significant gaps have been identified. Although 90% of emergency medicine residency program directors recognize the importance of residency training in oncologic emergencies, there is no standardized oncologic emergency curriculum. Objective We propose a focused oncologic EM curriculum that serves as a complement to existing EM didactics curriculums to prepare EM residents to recognize and manage the most common oncologic emergencies. ⋯ The proposed curriculum should be introduced during the first postgraduate year and then in the second or third year of the residency to reinforce the learning points. Conclusions Our proposal of a focused, standardized 10 hour program curriculum aims to help to fill the gaps in knowledge of oncologic emergencies. To assist in wide dissemination and standardization of these curriculum topics, outlines for each module are given in the article and we also propose creation of open access online lectures and content to be shared for education purposes.
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Ovarian hyperstimulation syndrome (OHSS) is the most serious complication of assisted reproductive technology. Severe OHSS may be accompanied by thromboembolic events, such as pulmonary thromboembolism or acute respiratory distress syndrome. Ischemic stroke may occur in rare cases. ⋯ We report a 32-year-old woman with a recent medical history of OHSS who presented to the emergency department (ED) with acute onset of impaired consciousness. Her initial Glasgow Coma Scale score was 10 (E3V3M4). History taking and a thorough physical examination were impossible because of the patient's mental status. Additional medical history was obtained with the assistance of the patient's husband. Ischemic stroke was confirmed on diffusion-weighted magnetic resonance imaging performed after a basic examination and confirmation of normal findings on a noncontrast brain computed tomography scan. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Although the incidence of cerebral infarction is low in younger patients, emergency physicians treating young women in the ED who have recently undergone fertility treatment or have been diagnosed with OHSS should be aware of the possibility of complications caused by OHSS. Specifically, if these patients complain of traditional or nontraditional neurologic symptoms during an ED visit, stroke should be strongly suspected.. This awareness will reduce the incidence of sequelae through prompt examination and treatment.