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A Serious Diagnosis Lacking Common Symptoms
​BY JENNIFER TUONG; IVAN KHARCHENKO; JEAN LUC AGARD; & AHMED RAZIUDDIN, MDA 65-year-old man who had HIV well-controlled with highly active antiretroviral therapy, hypertension, sciatica, and restless leg syndrome presented to the emergency department with left leg pain. He also had had chemotherapy and radiation for anal cancer. The patient said the pain had started 45 minutes earlier when he was sitting on the toilet.He described the pain as sore in quality and 10/10 on the pain scale. He reported that it had started in his lower back and radiated to his left leg. He said he had had no trauma or weakness to the regi...
Source: The Case Files - May 28, 2019 Category: Emergency Medicine Tags: Blog Posts Source Type: research

Severe Symptoms, but a Truly Treatable Disease
​BY NOURA MAHDI; DARRON LEWIS; JEREMY OSBORNE; & AHMED RAZIUDDIN, MDA 73-year-old man was brought to the emergency department from his nursing home for rectal bleeding and anemia. The patient mentioned he had had episodes of bright red rectal bleeding and constipation for a few months. A colonoscopy had been done prior to the visit, which revealed a large intestine tumor and biopsy confirming adenocarcinoma. He was awaiting an appointment with his surgeon.The patient reported bloody rectal leakage, and a CBC done at the nursing home showed a hemoglobin level of 7.2. He also complained of dyspnea but denied any other ...
Source: The Case Files - March 20, 2018 Category: Emergency Medicine Tags: Blog Posts Source Type: research

Single whole-leg compression ultrasound for exclusion of deep vein thrombosis in symptomatic ambulatory patients: a prospective observational cohort study
Conclusion Patients who have anticoagulation withheld following a negative or inconclusive whole leg CUS for suspected DVT have a low rate of adverse events at 3 months. Including the calf in ultrasound examination aided and clarified diagnosis in approximately one third of patients. Technical failure remains an issue: several factors were significantly associated with inconclusive results in our cohort and may warrant an alternative diagnostic approach Abstract 008 Table 1Measuring ED crowding Measure Operational DefinitionAbility of ambulances to offload patients.An ED is crowded when the 90th percentile time betwe...
Source: Emergency Medicine Journal - September 7, 2013 Category: Emergency Medicine Authors: Horner, D., Hogg, K., Body, R., Mackway-Jones, K. Tags: Drugs: cardiovascular system, Stroke, Venous thromboembolism, Radiology, Clinical diagnostic tests, Radiology (diagnostics) DAY 1: FOUR TOP SCORING CEM ABSTRACTS: ELGAR 2 12:00-13:00 Source Type: research

BET 1: Do patients with an asymptomatic sub-segmental pulmonary embolism need anticoagulation therapy?
A short cut review was carried out to establish whether therapeutic anticoagulation is required for patients who have an incidental diagnosis of subsegmental pulmonary embolism (PE), which is asymptomatic. 4 studies were relevant to the three-part question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these papers are tabulated. The evidence suggests that patients with clinically unsuspected PE may have better prognostic outcomes than those with symptomatic presentations, especially if the PE is at the sub-segmental level. The only direct...
Source: Emergency Medicine Journal - August 14, 2014 Category: Emergency Medicine Tags: EMJ Best evidence topic reports, Drugs: cardiovascular system, Stroke, Venous thromboembolism, Pulmonary embolism Source Type: research

Decreased facial expression variability in patients with serious cardiopulmonary disease in the emergency care setting
Conclusions With a single visual stimulus, patients with serious cardiopulmonary diseases lacked facial expression variability and surprise affect. Our preliminary findings suggest that stimulus-evoked facial expressions from emergency department patients with cardiopulmonary symptoms might be a useful component of gestalt pretest probability assessment.
Source: Emergency Medicine Journal - December 15, 2014 Category: Emergency Medicine Authors: Kline, J. A., Neumann, D., Haug, M. A., Kammer, D. J., Krabill, V. A. Tags: Editor's choice, Press releases, Pneumonia (infectious disease), TB and other respiratory infections, Pain (neurology), Stroke, Venous thromboembolism, Pneumonia (respiratory medicine), Pulmonary embolism Original article Source Type: research

Comparison of Four Bleeding Risk Scores to Identify Rivaroxaban‐treated Patients With Venous Thromboembolism at Low Risk for Major Bleeding
ConclusionsFour scoring systems that use criteria obtained in routine clinical practice, derived to predict low bleeding risk with VKA treatment for VTE, identified patients with less than a 1% risk of major bleeding during full‐course treatment with rivaroxaban.
Source: Academic Emergency Medicine - January 14, 2016 Category: Emergency Medicine Authors: Jeffrey A. Kline, David Jimenez, D. Mark Courtney, Juliana Ianus, Lynn Cao, Anthonie W.A. Lensing, Martin H. Prins, Philip S. Wells Tags: Original Contribution Source Type: research

Comparison of Four Bleeding Risk Scores to Identify Rivaroxaban-treated Patients With Venous Thromboembolism at Low Risk for Major Bleeding.
CONCLUSIONS: Four scoring systems that use criteria obtained in routine clinical practice, derived to predict low bleeding risk with VKA treatment for VTE, identified patients with less than a 1% risk of major bleeding during full-course treatment with rivaroxaban. PMID: 26765080 [PubMed - as supplied by publisher]
Source: Accident and Emergency Nursing - January 14, 2016 Category: Emergency Medicine Authors: Kline JA, Jimenez D, Courtney DM, Ianus J, Cao L, Lensing AW, Prins MH, Wells PS Tags: Acad Emerg Med Source Type: research

Should we be looking for and treating isolated calf vein thrombosis?
Management of isolated calf deep vein thrombosis is an area of significant international debate and variable clinical practice. Both therapeutic anticoagulation and conservative management carry risk. As clinical care of suspected and confirmed venous thromboembolic disease increasingly becomes the remit of emergency medicine, complex decisions are left to practising clinicians at the front door. We aim to provide a contemporary overview of recent evidence on this topic and associated challenges facing clinicians. Given the lack of high-level evidence, we present this work as a narrative review, based on structured literat...
Source: Emergency Medicine Journal - May 18, 2016 Category: Emergency Medicine Authors: Horner, D., Hogg, K., Body, R. Tags: Drugs: cardiovascular system, Stroke, Pregnancy, Venous thromboembolism, Pulmonary embolism Review Source Type: research

Fool Me Once: An Uncommon Presentation of PE
​BY FREDDIE IRIZARRY-DELGADO; VAROON KAKAIYA; & AHMED RAZIUDDIN, MDAn 86-year-old African-American woman was brought to the ED by her daughter after two days of nutritional neglect, abdominal pain, and altered mental status. Her daughter said her mother felt lightheaded, appeared dehydrated, and vomited nonbilious watery fluid once. The patient had a history of diabetes mellitus type 2, DVT/PE, dementia, and early signs of parkinsonism.Her vital signs were remarkable only for tachypnea (24 bpm). Her troponin I was markedly elevated at 1.7 ng/mL. A D-dimer was ordered because of her history of unprovoked DVT/PE, and i...
Source: The Case Files - November 27, 2018 Category: Emergency Medicine Tags: Blog Posts Source Type: research