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Specialty: Emergency Medicine
Condition: Pain

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Total 103 results found since Jan 2013.

Raising the bar for exclusion of acute venous thromboembolism in the emergency department
Conclusion Retrospective application of an age adjusted d-dimer cut point for exclusion of VTE in ths cohort significantly increased specificity with limited impact on sensitivity. Caveats include those patients with longstanding symptoms and those with isolated distal deep vein thrombosis. UK centres should consider further local validation and trial adoption.
Source: Emergency Medicine Journal - November 23, 2015 Category: Emergency Medicine Authors: Horner, D., Wells, S., Bonnici, K., Reeves, N., Parris, R. Tags: Drugs: cardiovascular system, Pain (neurology), Stroke, Venous thromboembolism, Clinical diagnostic tests RCEM FREE PAPERS Source Type: research

An EMS Guide to Wake-Up Ischemic Strokes
It’s 7:15 a.m. when the tones go off. “Squad 83 and ALS 83, respond for a 65-year-old female with a possible stroke,” squawks the dispatcher. Why did the last crew leave the radio on so loud? It’s too early for loud noises. Apparently your partner didn’t get the memo about loud noises either; he flips the siren to wail as soon as the wheels start to roll. You arrive to find Mrs. M, a pleasant older female who you’ve seen once or twice before for chest pain or palpitations. She seems to be staring into space, has an obvious facial droop, her arm drifts, her speech is slurred and the pleasant cheery lady you reme...
Source: JEMS Patient Care - November 20, 2015 Category: Emergency Medicine Authors: Michael Bohanske, MD Tags: Cardiac & Resuscitation Neurology Patient Care Source Type: news

Neurological disorders in the emergency centre of the Douala General Hospital, Cameroon: A cross-sectional study
Conclusion Neurological disorders are common in the emergency centre of the DGH. Aetiologies are diverse and in-hospital mortality is high. This highlights the need to organize neurologist calls at the EC and/or to improve the human resources capacity through regular training and evaluation.
Source: African Journal of Emergency Medicine - July 11, 2015 Category: Emergency Medicine Source Type: research

Management of Apixaban-Associated Subdural Hematoma: A Case Report on the Use of Factor Eight Inhibitor Bypassing Activity
Conclusions: Factor VIII inhibitor bypassing activity may be a viable, nonspecific reversal agent for life-threatening bleeding associated with apixaban.
Source: Critical Care Medicine - May 16, 2015 Category: Emergency Medicine Tags: Online Case Report Source Type: research

Cost-effectiveness of Quantitative Pretest Probability Intended to Reduce Unnecessary Medical Radiation Exposure in Emergency Department Patients With Chest Pain and Dyspnea.
CONCLUSIONS: Widespread use of a combined qPTP for both ACS and PE has the potential to decrease costs by reducing diagnostic testing, while improving most long-term outcomes in emergency patients with chest pain and dyspnea. PMID: 25899550 [PubMed - as supplied by publisher]
Source: Accident and Emergency Nursing - April 21, 2015 Category: Emergency Medicine Authors: Troyer JL, Jones AE, Shapiro NI, Mitchell AM, Hewer I, Kline JA Tags: Acad Emerg Med Source Type: research

Cost‐effectiveness of Quantitative Pretest Probability Intended to Reduce Unnecessary Medical Radiation Exposure in Emergency Department Patients With Chest Pain and Dyspnea
ConclusionsWidespread use of a combined qPTP for both ACS and PE has the potential to decrease costs by reducing diagnostic testing, while improving most long‐term outcomes in emergency patients with chest pain and dyspnea.
Source: Academic Emergency Medicine - April 21, 2015 Category: Emergency Medicine Authors: Jennifer L. Troyer, Alan E. Jones, Nathan I. Shapiro, Alice M. Mitchell, Ian Hewer, Jeffrey A. Kline Tags: Original Contribution Source Type: research

Ischemic Stroke Differential Diagnose: Spontaneous Spinal Epidural Hematoma can be fatal
Spontaneous Spinal Epidural Hematoma (SSEH) is rarely seen, it is the important reason for the spinal cord compression. Patients generally visit the doctor due to the acute pain in the neck and interscapular area. The male patient 58years old was admitted to the emergency service of our hospital with the sudden onset neck pain and followed by rapidly right hemiparesis He arrived at our hospital 120minutes after the onset of her symptoms with suspected acute stroke. We assessed for acute stroke performed clinical examinations necessary for intravenous thrombolytic treatment with alteplase, No abnormality was observed in his...
Source: The American Journal of Emergency Medicine - January 21, 2015 Category: Emergency Medicine Authors: Huseyin Buyukgol, M. Kemal Ilik, Faik Ilik 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

A pain in the neck
A 41-year-old woman presented to the emergency department after developing severe neck pain while unloading groceries. The pain began at the base of her neck, radiated to the vertex of the skull, reached maximum intensity within 2–3 min, and was aggravated by head movement. Neurological examination was normal. Head CT showed focal hyperattenuation immediately anterior to the midbrain (figure 1) and angiogram showed no evidence of aneurysm (see online supplementary figure 1). Diagnosis: Perimesencephalic nonaneurysmal subarachnoid haemorrhage (PN-SAH). Originally described in 1985,1 PN-SAH has been reported in pa...
Source: Emergency Medicine Journal - October 17, 2014 Category: Emergency Medicine Authors: Lindor, R. A., Homme, J. L. Tags: Headache (including migraine), Pain (neurology), Stroke, Ethics Images in emergency medicine Source Type: research

Short answer question case series: a case of upper extremity oedema
Case vignette A right-handed man without past medical history presents with right upper extremity oedema for 4 days. He does not endorse any history of trauma, but was weight lifting and trampoline jumping 2 days prior to symptom development (see figures 1–4). Key questions Which visual findings are of notable concern? What are other important considerations on history? How should this patient be evaluated? How should this patient be treated? What should this patient's disposition be?Figure 1 depicts the forearms. The right arm is erythematous and oedematous compared with the left. Figures 2 and 3...
Source: Emergency Medicine Journal - September 16, 2014 Category: Emergency Medicine Authors: Tzvetkova, E., Jang, T. Tags: Fractures, Drugs: cardiovascular system, Pain (neurology), Stroke, Venous thromboembolism, Radiology, Clinical diagnostic tests, Radiology (diagnostics), Trauma SAQs Source Type: research

The Case Files: When a Spade is Not a Spade
Turrin, Danielle DO; Sattler, Steven DO; Amodeo, Dana DO A 25-year-old Hispanic man presented to the emergency department with a complaint of three days of left-sided precordial chest pain. He described the pain as a constant 6/10 with pressure-like discomfort radiating to his left arm and the left side of his neck. He also experienced nausea, but denied any provocative or palliative factors. He said he had not experienced anything similar to this before. He had no family history of heart disease, acute myocardial infarction, or sudden cardiac death. He admitted to a 1.5 pack-per-day smoking history and social alcohol use,...
Source: The Case Files - August 26, 2014 Category: Emergency Medicine Tags: Blog Posts Source Type: research

Simultaneous event of brachial artery occlusion and acute embolic stroke
Although the rapid and accurate diagnosis of both acute ischemic stroke and extremity ischemia is essential to the timely and appropriate treatment, it is not always easy to differentiate between true stroke and stroke mimics. Although in general, limb ischemia due to extremity embolism is not included in stroke mimics or misdiagnosis, limb arterial embolism should be considered in the differential diagnosis of acute monoparesis because the diagnosis may be missed if the other typical manifestations of this presentation (pain, pallor, pulselessness, sensory loss, and coolness of the arm) are overlooked.
Source: The American Journal of Emergency Medicine - August 26, 2014 Category: Emergency Medicine Authors: Soo Hoon Lee, Nack-Cheon Choi, In Seok Jang, Tae-Sin Kang, Changwoo Kang, Jin Hee Jeong, Dong Seob Kim Tags: Case Report Source Type: research

The Case Files: Traumatic Carotid Dissection
By Hsiao, Jonie MD   A 30-year-old man who was right-hand dominant presented 10 days after sustaining left-sided face and head trauma from a fall from a skateboard at an unknown speed. He lost consciousness for several seconds, and initially developed a headache with nausea and vomiting. A non-contrast head CT performed at another hospital done two days after the incident was reportedly negative.   He now presents primarily with concerns about the appearance of his left eye. He has notable anisocoria and a droopy eyelid. His left pupil is notably smaller, 2 mm, compared with the right eye, 5 mm. Both are reactive. The re...
Source: The Case Files - June 4, 2014 Category: Emergency Medicine Tags: Blog Posts Source Type: research

The utility of copeptin in the emergency department as a predictor of adverse outcomes in non-ST-elevation acute coronary syndrome: the COPED-PAO study
Conclusions In patients with NSTEACS, determination of copeptin at presentation to the ED is associated with risk of death during the subsequent month. This association, however, disappears after adjusting by baseline features or troponin level, so copeptin does not add complementary prognostic information over that provided by troponin.
Source: Emergency Medicine Journal - March 12, 2014 Category: Emergency Medicine Authors: Sanchez, M., Llorens, P., Herrero, P., Martin-Sanchez, F. J., Pinera, P., Miro, O., on behalf of COPEP study investigators, Alvarez-Medina, Pavon Monzo, Perez Dura, Valles Tarazona, Garcia, Poblador, Castro, Jimenez, Lopez, Morales, del Castillo, Artacho, Tags: Drugs: cardiovascular system, Pain (neurology), Stroke Original article Source Type: research