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Emergency department chest pain

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https://www.readbyqxmd.com/read/29338968/an-alternative-tool-for-triaging-patients-with-possible-acute-coronary-symptoms-before-admission-to-a-chest-pain-unit
#1
Kuang-Chau Tsai, Ray F Lin, Chieh Lee, Ai-Hsien Li
OBJECTIVE: This study aimed to develop a triage tool to more effectively triage possible ACS patients presenting to the emergency department (ED) before admission to a protocol-driven chest pain unit (CPU). METHODS: Seven hundred ninety-three clinical cases, randomly selected from 7962 possible ACS cases, were used to develop and test an ACS triage model using cluster analysis and stepwise logistic regression. RESULTS: The ACS triage model, logit (suspected ACS patient)=-5...
December 13, 2017: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29338966/family-history-of-venous-thromboembolism-predicts-the-diagnosis-of-acute-pulmonary-embolism-in-the-emergency-department
#2
Christopher Kelly, Chad Agy, Margaret Carlson, Jacob Steenblik, Joseph Bledsoe, Stephen Hartsell, Troy Madsen
BACKGROUND: Pulmonary embolism (PE) clinical decision rules do not consider a patient's family history of venous thromboembolism (VTE). We evaluated whether a family history of VTE predicts acute PE in the emergency department (ED). METHODS: Over a 5.5-year study period, we enrolled a prospective convenience sample of patients presenting to an academic emergency department with chest pain and/or shortness of breath. We defined a family history of VTE as a first-degree relative with previous PE or deep vein thrombosis (DVT)...
January 6, 2018: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29338163/kounis-syndrome-induced-by-oral-intake-of-diclofenac-potassium
#3
Harun Gunes, Feruza Turan Sonmez, Ayhan Saritas, Yasin Koksal
An acute coronary syndrome (ACS) occurring during the course of an allergic reaction is called Kounis syndrome (KS). The second case of KS induced by diclofenac potassium (DP) is presented in this report. A 67-year-old man was brought to our emergency department with the possible diagnosis of anaphylactic shock by the ambulance staff. It emerged that widespread erythema and pruritus developed after taking DP. Then, he lost consciousness. Diffuse urticarial lesions were detected on physical examination at the emergency department...
December 2017: Iranian Journal of Allergy, Asthma, and Immunology
https://www.readbyqxmd.com/read/29336989/are-geriatric-patients-placed-in-an-emergency-department-observation-unit-on-a-chest-pain-pathway-more-likely-than-non-geriatric-patients-to-re-present-to-the-hospital-within-30%C3%A2-days
#4
Christopher C Gruenberg, Alan H Breaud, James H Liu, Patricia M Mitchell, James A Feldman, Kerrie P Nelson, Joseph H Kahn
BACKGROUND: Emergency department observation units (EDOUs) are used frequently for low-risk chest pain evaluations. OBJECTIVE: The purpose of this study was to determine whether geriatric compared to non-geriatric patients evaluated in an EDOU for chest pain have differences in unscheduled 30-day re-presentation, length of stay (LOS), and use of stress testing. METHODS: We conducted an exploratory, retrospective, cohort study at a single academic, urban ED of all adult patients placed in an EDOU chest pain protocol from June 1, 2014 to May 31, 2015...
January 11, 2018: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29335793/accuracy-of-emergency-department-triage-using-the-emergency-severity-index-and-independent-predictors-of-under-triage-and-over-triage-in-brazil-a-retrospective-cohort-analysis
#5
Jeremiah S Hinson, Diego A Martinez, Paulo S K Schmitz, Matthew Toerper, Danieli Radu, James Scheulen, Sarah A Stewart de Ramirez, Scott Levin
BACKGROUND: Emergency department (ED) triage is performed to prioritize care for patients with critical and time-sensitive illness. Triage errors create opportunity for increased morbidity and mortality. Here, we sought to measure the frequency of under- and over-triage of patients by nurses using the Emergency Severity Index (ESI) in Brazil and to identify factors independently associated with each. METHODS: This was a single-center retrospective cohort study. The accuracy of initial ESI score assignment was determined by comparison with a score entered at the close of each ED encounter by treating physicians with full knowledge of actual resource utilization, disposition, and acute outcomes...
January 15, 2018: International Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29326821/age-sex-and-gene-expression-score-identifies-a-symptomatic-nondiabetic-male-patient-as-being-at-high-risk-of-obstructive-coronary-artery-disease
#6
Ronald J Polinsky
In October 2015, a 74-year-old Caucasian male patient (past medical history of hyperlipidemia, paroxysmal atrial fibrillation, hypertension, and hypothyroidism) presented to the cardiologist for follow-up outpatient evaluation of exertional chest pain. The patient had recently been seen at the Emergency Department for the same complaint. At that time, the patient's cardiac markers, EKG, and pharmacological nuclear stress testing were all reported as normal. At presentation to the cardiologist, the patient's physical examination findings were unremarkable...
2018: SAGE Open Medical Case Reports
https://www.readbyqxmd.com/read/29324936/the-impact-of-lung-perfusion-scintigraphy-in-the-emergency-management-of-patients-with-suspected-pulmonary-embolism
#7
Cristina Ferrari, Alessandra Cimino, Giacomo Bianco, Francesca Iuele, Alessandra Di Palo, Margherita Fanelli, Artor Niccoli-Asabella, Giuseppe Rubini
OBJECTIVE: Pulmonary Embolism (PE) is an emergency condition that requires immediate treatment. As the symptoms and the risk factors are nonspecific, PE differential diagnosis is often required. Even if angio-CT is considered the gold standard for PE diagnosis, the frequent allergic condition and/or chronic renal failure of patients make, in most cases, not possible the use of contrast enhancement in emergency with even more increasing use of Lung Perfusion Scintigraphy (LPS), as a simple and fast examination with no preparation/contraindication...
September 2017: Hellenic Journal of Nuclear Medicine
https://www.readbyqxmd.com/read/29320381/a-brief-interview-to-detect-panic-attacks-and-panic-disorder-in-emergency-department-patients-with-cardiopulmonary-complaints
#8
Sharon C Sung, A John Rush, Arul Earnest, Leslie E C Lim, Maeve P P Pek, Joen M F Choi, Magdalene P K Ng, Marcus E H Ong
OBJECTIVES: Patients with panic-related anxiety often initially present to the emergency department (ED) complaining of respiratory or cardiac symptoms, but rates of detection of panic symptoms by ED physicians remain low. This study was undertaken to evaluate the relevance of panic attacks and panic disorder in ED patients who present with cardiopulmonary symptoms and to determine whether a brief symptom-based tool could be constructed to assist in rapid recognition of panic-related anxiety in the ED setting...
January 2018: Journal of Psychiatric Practice
https://www.readbyqxmd.com/read/29319833/spontan-pneumomediastinum-ovanlig-orsak-till-akut-br%C3%A3-stsm%C3%A3-rta
#9
Carl Wengse, Gustav Bolinder, Emil Aman
A previously healthy 21-year old man presented to the emergency department with sudden onset central chest pain exacerbated by breathing. A plain chest X-ray showed air within the mediastinum and pericardium confirmed by a CT scan with contrast. The patient history did not raise suspicion of any concomitant disease and the diagnosis of spontaneous pneumomediastinum with pneumopericardium was made. The patient recovered completely over the next few days with bed rest and analgesics. Spontaneous pneumomediastinum is an uncommon disease caused by rupture of perivascular alveoli causing air leakage to the mediastinum...
January 9, 2018: Läkartidningen
https://www.readbyqxmd.com/read/29319020/rib-desmoplastic-fibroblastoma-video-assisted-resection
#10
Agustin Buero, Walter Sebastian Nardi, Gustavo Alejandro Lyons, Pablo Dezanzo
A 46-year-old man was referred to our department due to chronic chest pain. A computed tomography showed an exophytic image arising from 5th rib that was projected on the middle lobule. The patient underwent an exploratory videothoracoscopic because we couldn't discard lung compromise. A corneal-like lesion emerging from the inner side of the 5th rib was revealed. Complete video-assited resection was done. Histopathology examination revealed a desmoplastic fibroblastoma. To our knowledge this is the first case of desmoplastic fibroblastoma arising from a rib and the second case published in all literature of chest wall involvement...
January 10, 2018: Journal of Minimal Access Surgery
https://www.readbyqxmd.com/read/29317021/proposed-clinical-scale-for-the-diagnosis-of-acute-coronary-syndrome-in-patients-with-an-inconclusive-electrocardiogram-and-myocardial-injury-biomarkers
#11
F J Montero-Pérez, F B Quero-Espinosa, M J Clemente-Millán, J A Castro-Giménez, J de Burgos-Marín, M Á Romero-Moreno
RATIONALE: Acute coronary syndrome (ACS) requires improved diagnostic accuracy through useful, safe and easy-to-apply tools. OBJECTIVES: To obtain an assessment scale for the diagnosis of ACS in patients with chest pain and nondiagnostic electrocardiogram and troponin concentrations. METHODS: A prospective cohort study included 286 patients treated in the emergency department for chest pain, with normal electrocardiogram and troponin levels...
January 6, 2018: Revista Clínica Española
https://www.readbyqxmd.com/read/29316995/prehospital-modified-heart-score-predictive-of-30-day-adverse-cardiac-events
#12
Jason P Stopyra, William S Harper, Tyson J Higgins, Julia V Prokesova, James E Winslow, Robert D Nelson, Roy L Alson, Christopher A Davis, Gregory B Russell, Chadwick D Miller, Simon A Mahler
Introduction The History, Electrocardiogram (ECG), Age, Risk Factors, and Troponin (HEART) score is a decision aid designed to risk stratify emergency department (ED) patients with acute chest pain. It has been validated for ED use, but it has yet to be evaluated in a prehospital setting. Hypothesis A prehospital modified HEART score can predict major adverse cardiac events (MACE) among undifferentiated chest pain patients transported to the ED. METHODS: A retrospective cohort study of patients with chest pain transported by two county-based Emergency Medical Service (EMS) agencies to a tertiary care center was conducted...
January 10, 2018: Prehospital and Disaster Medicine
https://www.readbyqxmd.com/read/29310702/mondor-s-disease-a-rare-cause-of-chest-pain-a-case-report
#13
Navaneethakrishnan Suganthan, Vithiya Ratnasamy
BACKGROUND: Chest pain is one of the common presenting symptoms encountered in an emergency department. Prompt history taking and careful clinical examination do help to differentiate cardiac chest pain from other causes. Mondor's disease is a rare cause of chest pain which is often underdiagnosed due to lack of awareness. Mondor's disease is a condition characterized by thrombophlebitis of the superficial veins of breast and anterior chest wall. The diagnosis is often made clinically...
January 9, 2018: Journal of Medical Case Reports
https://www.readbyqxmd.com/read/29310365/ebv-lymphoproliferative-associated-disease-and-primary-cardiac-t-cell-lymphoma-in-a-stk4-deficient-patient-a-case-report
#14
Roya Sherkat, Mohammad Reza Sabri, Bahar Dehghan, Hamid Bigdelian, Nahid Reisi, Nooshin Afsharmoghadam, Hamid Rahimi, Narges Rahmanian, Cristoph Klein
RATIONALE: Primary cardiac lymphoma (PLC) is an extremely uncommon malignancy. PCL is more common in secondary immunodeficient patients. In this report, we describe a unique case of PLC who had been diagnosed as a STK4 deficient patient. This case is the first Primary immunodeficiency (PID) patient developing PCL in the world. PATIENT CONCERNS: An eleven-year-old girl, a known case of PID, was referred to the pediatric cardiology department because of chest pain and dyspnea...
December 2017: Medicine (Baltimore)
https://www.readbyqxmd.com/read/29306269/sealone-safety-and-efficacy-of-coronary-computed-tomography-angiography-with-low-dose-in-patients-visiting-emergency-room-trial-study-protocol-for-a-randomized-controlled-trial
#15
Joonghee Kim, Joon-Won Kang, Kyuseok Kim, Sang Il Choi, Eun Ju Chun, Yeo Goon Kim, Won Young Kim, Dong Woo Seo, Jonghwan Shin, Huijai Lee, Kwang-Nam Jin, Soyeon Ahn, Seung Sik Hwang, Kwang Pyo Kim, Ru-Bi Jeong, Sang Ook Ha, Byungho Choi, Chang-Hwan Yoon, Jung-Won Suh, Hack-Lyoung Kim, Ju Kyoung Kim, Sujin Jang, Ji Seon Seo
OBJECTIVE: Chest pain is one of the most common complaints in the emergency department (ED). Cardiac computed tomography angiography (CCTA) is a frequently used tool for the early triage of patients with low- to intermediate-risk acute chest pain. We present a study protocol for a multicenter prospective randomized controlled clinical trial testing the hypothesis that a low-dose CCTA protocol using prospective electrocardiogram (ECG)-triggering and limited-scan range can provide sufficient diagnostic safety for early triage of patients with acute chest pain...
December 2017: Clinical and Experimental Emergency Medicine
https://www.readbyqxmd.com/read/29303766/no-additional-value-of-conventional-and-high-sensitivity-cardiac-troponin-over-clinical-scoring-systems-in-the-differential-diagnosis-of-type-1-versus-type-2-myocardial-infarction
#16
Luciano Consuegra-Sánchez, Juan José Martínez-Díaz, Luis García de Guadiana-Romualdo, Samantha Wasniewski, Patricia Esteban-Torrella, Francisco Guillermo Clavel-Ruipérez, Alfredo Bardají, Juan Antonio Castillo-Moreno, Juan Carlos Kaski
BACKGROUND: The distinction of type 1 and type 2 myocardial infarction (MI) is of major clinical importance. Our aim was to evaluate the diagnostic ability of absolute and relative conventional cardiac troponin I (cTnI) and high-sensitivity cardiac troponin T (hs-cTnT) in the distinction between type 1 and type 2 MI in patients presenting at the emergency department with non-ST-segment elevation acute chest pain within the first 12 h. METHODS: We measured cTnI (Dimension Vista) and hs-cTnT (Cobas e601) concentrations at presentation and after 4 h in 200 patients presenting with suspected acute MI...
January 5, 2018: Clinical Chemistry and Laboratory Medicine: CCLM
https://www.readbyqxmd.com/read/29296770/osteonecrosis-of-the-femoral-head-in-sickle-cell-disease-prevalence-comorbidities-and-surgical-outcomes-in-california
#17
Oyebimpe Adesina, Ann Brunson, Theresa H M Keegan, Ted Wun
Osteonecrosis of the femoral head (ONFH) is a prevalent complication of sickle cell disease (SCD) that has not been well described in population-based cohort studies. Using California's Office of Statewide Planning and Development discharge databases (1991-2013), we estimated the cumulative incidence of ONFH after accounting for the competing risk of death and used a multivariable Cox proportional hazards regression to identify factors associated with ONFH diagnosis. We also calculated rates of readmissions to the hospital or emergency department within 30 to 90 days of hip replacement surgery...
July 11, 2017: Blood Advances
https://www.readbyqxmd.com/read/29290506/thigh-emphysema-as-the-initial-presentation-of-colon-ischemia
#18
Chin-Chuan Hsu, Ping-Yuan Chen, Chih-Cheng Lai
The incidence of colon ischemia has increased in recent years, and is associated with high morbidity and mortality. The typical presentations of colon ischemia include abdominal pain, bloody diarrhea, and in severe case, ileus, fever and peritonitis. Here, we document a rare case of colon ischemia presenting with subcutaneous and intramuscular emphysema of the thigh. A 76-year-old woman presented to the emergency department for left thigh pain for three days. Physical examination revealed tenderness without obvious crepitus, erythema or swelling over the left groin area and a soft abdomen without tenderness...
December 6, 2017: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29289400/shared-decision-making-as-the-future-of-emergency-cardiology
#19
REVIEW
Marc A Probst, Peter A Noseworthy, Juan P Brito, Erik P Hess
Shared decision-making is playing an increasingly large role in emergency cardiovascular care. Although there are many challenges to successfully performing shared decision-making in the emergency department, there are numerous clinical scenarios in which it should be used. In this article, we explore new research and emerging decision aids in the following emergency care scenarios: (1) low-risk chest pain; (2) new-onset atrial fibrillation; and (3) moderate-risk syncope. These decision aids are designed to engage patients and facilitate shared decision-making for specific treatment and disposition (admit vs discharge) decisions...
September 22, 2017: Canadian Journal of Cardiology
https://www.readbyqxmd.com/read/29275346/clinical-features-and-prognosis-of-patients-with-acute-non-specific-chest-pain-in-emergency-and-cardiology-departments-after-the-introduction-of-high-sensitivity-troponins-a-prospective-cohort-study
#20
Nivethitha Ilangkovan, Hans Mickley, Axel Diederichsen, Annmarie Lassen, Thomas L Sørensen, Hussam Mahmoud Sheta, Peter B Stæhr, Christian Backer Mogensen
OBJECTIVES: To determine the incidence of clinical, cardiac-related endpoints and mortality among patients presenting to an emergency or cardiology department with non-specific chest pain (NSCP), and who receive testing with a high-sensitivity troponin. A second objective was to identify risk factors for the above-noted endpoints during 12 months of follow-up. DESIGN: A prospective multicentre study. SETTING: Emergency and cardiology departments in Southern Denmark...
December 22, 2017: BMJ Open
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