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71.
T.G. Rajaoharimalala T. Rajaobelison R.N.A.L. Rakotorahalahy L. Ramiliarijaona M.L.A. Ravalisoa A.J.C. Rakotoarisoa 《Annales de cardiologie et d'angeiologie》2021,70(1):54-56
Delayed post-traumatic pericardial effusion is a rare condition after blunt trauma. The diagnosis of the effusion can be made by the clinical signs, which is not very specific and the cardiac echography. The etiological diagnosis remains difficult because it requires the elimination of the other causes of pericarditis. Their treatment consists in evacuating the pericardial effusion. The evolution thereafter is simple. We report four cases of patients with pericardial effusion late after a thoracic injury. Imaging the blood test, the examination of the pericardial fluid and the anatomopathological examination of the pericardium, eliminates the other etiologies. 相似文献
72.
Gregory Gafni-Pappas Susanne D. DeMeester Michael A. Boyd Arun Ganti Adam M. Nicholson Jeremy Albright Juan Wu 《The American journal of emergency medicine》2018,36(10):1825-1831
Objective
The HAS-Choice pathway utilizes the HEART Score, an accelerated diagnostic protocol (ADP), and shared decision-making using a visual aid in the evaluation of chest pain patients. We seek to determine if our intervention can improve resource utilization in a community emergency department (ED) setting while maintaining safe patient care.Methods
This was a single-center prospective cohort study with historical that included ED patients ≥21 years old presenting with a primary complaint of chest pain in two time periods. The primary outcome was patient disposition. Secondary outcomes focused on 30-day ED bounce back and major adverse cardiac events (MACE). We used multivariate logistic regression to estimate the odds ratio (OR) and its 95% confidence interval (CI).Results
In the pre-implementation period, the unadjusted disposition to inpatient, observation and discharge was 6.5%, 49.1% and 44.4%, respectively, whereas in the post period, the disposition was 4.8%, 41.5% and 53.7%, respectively (chi-square p < 0.001). The adjusted odds of a patient being discharged was 40% higher (OR = 1.40; 95% CI, 1.30, 1.51; p < 0.001) in the post-implementation period. The adjusted odds of patient admission was 30% lower (OR = 0.70; 95% CI, 0.60, 0.82; p < 0.001) in the post-implementation period. The odds of 30-day ED bounce back did not statistically differ between the two periods. MACE rates were <1% in both periods, with a significant decrease in mortality in the post-implementation period.Conclusion
Our study suggests that implementation of a shared decision-making tool that integrates an ADP and the HEART score can safely decrease hospital admissions without an increase in MACE. 相似文献73.
Jonathan S. Schiffman 《The American journal of emergency medicine》2018,36(2):342.e3-342.e5
Patients presenting to the emergency department with chest pain are common and a cause of significant concern to patients and families and physicians alike. The causes of chest pain are myriad. These causes span diverse categories including cardiovascular, respiratory, abdominal and gastrointestinal, musculoskeletal, psychiatric, hematologic and oncologic, and neurologic Thull-Freedman (2010) [1]. These diverse etiologies present a diagnostic and management challenge to the ER physician who is tasked to minimize unnecessary diagnostics while not missing any significant disease. Multiple reviews have discussed the various etiologies of chest pain in the pediatric patient presenting to the ER but none of these recent reviews has included hypokalemia as a cause of chest pain Talner and Carboni (2000), Cava and Sayger (2004), Ringstrom and Freedman (2006), Foy and Filippone (2015), Yeh and Yeh (2015) [2], [3], [4], [5], [6]. Additionally, no reviews of hypokalemia describe this condition presenting with chest pain (Mandal, 1997; Gennari, 2002; Medford-Davis and Rafique, 2014 [7], [8], [9]).This case report describes a pediatric patient who presents with chest pain that was attributed to hypokalemia. This report attempts to make practitioners aware that hypokalemia may present with chest pain and to encourage ER providers to include this in the differential diagnosis. 相似文献
74.
目的初步探讨情绪障碍在彝族冠心病患者胸痛中的作用。方法观察彝族冠心病患者抑郁的发生率及严重程度,抗抑郁治疗前后胸痛的特点。结果彝族冠心病患者存在明显的情绪障碍,抗抑郁治疗后胸痛、每周发作次数、发作时 ST 段下移程度和胸痛持续时间均较抗抑郁治疗前明显改善。结论彝族冠心病患者胸痛发作时,抑郁是其中很重要的机制。 相似文献
75.
Sumal Nandasena Chaminda Senavirathna Champa Munasinghe Chapa Wijesena Ridmi Sucharitharathna 《The Indian journal of tuberculosis》2019,66(1):76-80
Background
Tuberculosis (TB) is an infectious bacterial disease; remains as one of the important public health problem affecting every part of the world. Substantial number of TB cases are reported from Sri Lanka every year irrespective of its strong preventive health system. The aim of this analysis is to describe the characteristics of TB patients and to assess the factors associated with sputum conversion. This analysis was based on the data from the District Chest Clinic of Kalutara district, Sri Lanka.Methods
Information of all newly diagnosed and registered patients in the District Chest Clinic, Kalutara in year 2013 were ascertained. Out of 687 newly reported TB patients, 669 records were included in final analysis.Results
Majority of patients were males (n = 451, 67.4%), in the age group of 36–60 years (n = 306, 45.7%) and underweight (n = 359, 61.7%). Substantial proportion of normal weight or overweight adult patients (92.1%) had sputum conversion at 2–3 months as compared to underweight adult patients (82.5%) (p = 0.034). Those who smoke tobacco is less likely to have sputum conversion at 2–3 months as compared to non-smokers (90.2% vs. 82.1%, p = 0.045).Conclusion
Provision of good nutrition, maintaining of appropriate body mass index (i.e., BMI), and abstinence from smoking and alcohol consumption are important for sputum conversion among smear-positive pulmonary TB patients. 相似文献76.
77.
《Radiologia》2022,64(3):214-227
ObjectivesTo develop prognosis prediction models for COVID-19 patients attending an emergency department (ED) based on initial chest X-ray (CXR), demographics, clinical and laboratory parameters.MethodsAll symptomatic confirmed COVID-19 patients admitted to our hospital ED between February 24th and April 24th 2020 were recruited. CXR features, clinical and laboratory variables and CXR abnormality indices extracted by a convolutional neural network (CNN) diagnostic tool were considered potential predictors on this first visit. The most serious individual outcome defined the three severity level: 0) home discharge or hospitalization ≤ 3 days, 1) hospital stay >3 days and 2) intensive care requirement or death. Severity and in-hospital mortality multivariable prediction models were developed and internally validated. The Youden index was used for the optimal threshold selection of the classification model.ResultsA total of 440 patients were enrolled (median 64 years; 55.9% male); 13.6% patients were discharged, 64% hospitalized, 6.6% required intensive care and 15.7% died. The severity prediction model included oxygen saturation/inspired oxygen fraction (SatO2/FiO2), age, C-reactive protein (CRP), lymphocyte count, extent score of lung involvement on CXR (ExtScoreCXR), lactate dehydrogenase (LDH), D-dimer level and platelets count, with AUC-ROC = 0.94 and AUC-PRC = 0.88. The mortality prediction model included age, SatO2/FiO2, CRP, LDH, CXR extent score, lymphocyte count and D-dimer level, with AUC-ROC = 0.97 and AUC-PRC = 0.78. The addition of CXR CNN-based indices did not improve significantly the predictive metrics.ConclusionThe developed and internally validated severity and mortality prediction models could be useful as triage tools in ED for patients with COVID-19 or other virus infections with similar behaviour. 相似文献
78.
79.
Chest pain on questionnaire and prediction of major ischaemic heart disease events in men 总被引:2,自引:0,他引:2
Lampe F.C.; Whincup P.H.; Wannamethee S.G.; Ebrahim S.; Walker M.; Shaper A.G. 《European heart journal》1998,19(1):63-73
Objective To examine the prediction of major ischaemic heartdisease events by questionnaire-assessed chest pain and othersymptoms. Design Population-based prospective study. Subjects 7735 randomly selected men, aged 4059 yearsat entry. Methods Symptoms and history of diagnosed ischaemic heart diseasewere ascertained by administered questionnaire at baseline.Follow-up was for an average of 14·7 years, for firstmajor ischaemic heart disease event. Results During follow-up, 969 men had a major ischaemic heartdisease event. Definite angina (chest pain fulfillingall WHO criteria) and possible angina (exertionalchest pain without all other WHO criteria) were associated withsimilar ischaemic heart disease outcome, and a single combinedangina category was used. In the whole cohort, the relativerisks (95% CI) of a major ischaemic heart disease event were2·03 (1·61, 2·57) for angina only, 2·13(1·72, 2·63) for possible myocardial infarctiononly and 4·50 (3·57, 5·66) for angina pluspossible myocardial infarction, compared to no chest pain. Therelative risk for recall of an ischaemic heart disease diagnosiswas 3·98 (3·36, 4·71). Only 33% of menwith angina or possible myocardial infarction symptoms recalleda previous ischaemic heart disease diagnosis. In men withoutrecall of an ischaemic heart disease diagnosis (in whom 82%of events during follow-up occurred), chest pain symptoms remainedpredictive of major ischaemic heart disease events with relativerisks (95% CI) of 1·69 (1·27, 2·24) forangina only, 1·49 (1·12, 1·97) for possiblemyocardial infarction only and 2·55 (1·44, 4·53)for angina plus possible myocardial infarction. Otherchest pain increased risk of a major ischaemic heartdisease event by 1·19 (1·01, 1·40) comparedto no chest pain. Symptoms of breathlessness or calf pain onwalking increased ischaemic heart disease risk in men with otherchest pain and in men without chest pain, but had nofurther effect on ischaemic heart disease risk in men with symptomsof angina or possible myocardial infarction. Conclusions In defining angina by chest pain questionnaire,the exertional component is the crucial criterion. When usingquestionnaire-assessed symptoms to determine ischaemic heartdisease risk, information on previous ischaemic heart diseasediagnoses should be taken into account. The majority of menwith angina or possible myocardial infarction symptoms do nothave a diagnosis of ischaemic heart disease, but they remainat significantly increased risk of a major ischaemic heart diseaseevent. The value of breathlessness and calf pain on walkingin stratifying ischaemic heart disease risk is restricted tomen with other chest pain or no chest pain. 相似文献
80.
Michael Hight Kasey Conklin Benjamin Archer Jared Sutherland Brandi Sakai Dylan Arnold 《Journal of emergency nursing》2021,47(2):299-304
IntroductionIn the emergency department, troponin assays are commonly used and essential in the evaluation of chest pain and diagnosis of acute coronary syndrome. This study was designed to assess the potential impact of implementing point-of-care troponin testing by comparing the time to point-of-care laboratory result and time to conventional laboratory result.MethodsThe study enrolled 60 ED patients deemed to need a troponin test in the evaluation of low-risk chest pain (HEART score <4 based on history, electrocardiogram, age, risk factors). Point-of-care troponin testing was performed with the same blood sample obtained for a conventional troponin assay. If the provider determined that the patient required 2 troponin tests, the second laboratory draw was used in the data collection. This was to correlate the time of laboratory result to time of disposition.ResultsOf the 60 subjects enrolled, 2 subjects were excluded because of user errors with the point-of-care testing equipment and 2 others for not meeting inclusion criteria on later review. The median times for the point-of-care troponin and conventional troponin assays were 11:00 minutes (interquartile range 10:00-15:30) and 40:00 minutes (interquartile range 31:30-52:30), respectively; P < 0.001. There were 3 extreme outliers from the conventional troponin assay that significantly skewed the distribution of the mean, making the median the more accurate assessment of the central tendency.DiscussionPoint-of-care troponin testing provided results in a median time 29 minutes quicker than the conventional troponin assay. This result is statistically significant and has the potential to greatly improve time to disposition in all patients with chest pain requiring a troponin assay. 相似文献