scholarly journals Outcomes in patients with history of cocaine use presenting with chest pain to the emergency department: Insights from the Nationwide Emergency Department Sample 2016–2018

2022 ◽  
Vol 3 (1) ◽  
Author(s):  
Farhad Sami ◽  
Wan‐Chi Chan ◽  
Prakash Acharya ◽  
Prince Sethi ◽  
Chad Cannon ◽  
...  
Keyword(s):  
Emergency Department ◽  
Chest Pain ◽  
Cocaine Use ◽  
History Of

Abstract 115: Predictors Of A Positive Stress Test Among Patient Presenting To The Emergency Department With Chest Pain

2014 ◽  
Vol 7 (suppl_1) ◽  
Author(s):  
Taraka V Gadiraju ◽  
Jahnavi Sagi ◽  
Dev Basu ◽  
Srikanth Penumetsa ◽  
Michael Rothberg
Keyword(s):  
Emergency Department ◽  
Chest Pain ◽  
Stress Test ◽  
Tertiary Care ◽  
Face Validity ◽  
Pseudorandom Number Generator ◽  
Multivariable Model ◽  
Final Multivariable Model ◽  
Significant Difference ◽  
History Of

Objectives: Patients frequently present to the hospital with chest pain. Once myocardial infarction is ruled out based on EKG and cardiac enzymes, most patients undergo stress testing, but only few patients have a positive test. In ambulatory practice, age, sex and symptomatology can establish pretest probability of the coronary disease. However, there are no studies evaluating the predictors of a positive stress test in the emergency department (ED). We assessed predictors for a positive stress test in patients presenting to our hospital with chest pain. Methods: This is a case-control study conducted on a subset of patients admitted to our tertiary care center with chest pain between 2007 and 2009, and who had an inpatient stress test (n=1474). Using chart review, we identified 87 patients, whose stress tests were positive (abnormals), defined as presence of ischemia on EKG and/or imaging modalities. We then used a pseudorandom number generator to select 194 patients whose stress test results were normal (normals) for comparison. Clinical features of chest pain and CAD risk factors were abstracted from the medical record for comparison. A bivariable screening process was used to identify characteristics for inclusion in a multivariable predictive model. Sex and age were maintained in the model for face validity, and remaining covariates were removed in ascending order of their z-statistics until only those with a two-sided p-value of <0.10 remained. Stata 12.1 (Copyright 2011, StataCorp LP) was used for all analyses. Results: Patients with an abnormal stress test were older and more likely to be male and to have a history of vascular disease. Although patients with abnormal stress test were more likely to have history of hypertension, hyperlipidemia and current or ex-smoking, this difference was not statistically significant. Over half of the patients presented with non-cardiac chest pain and there was no significant difference in the chest pain characteristics between patients who had a normal and an abnormal stress test result. In the final multivariable model, when compared to the normals, abnormals were four times as likely to have a history of revascularization (OR 4.13, 95% CI 2.11, 8.09) and twice as likely to have a history of hyperlipidemia (OR 2.1, 95% CI 1.18, 3.79). They were also more likely to have an EKG suggestive of ischemia at presentation (OR 1.90, 95% CI 1.03, 3.53). Specificity of the model was 89%; sensitivity was 43%, and the c-statistic for the final multivariable model was 0.76, suggesting fair to good discrimination. Conclusions: Among patients presenting to the ED with chest pain, a past history of revascularization and hyperlipidemia and an EKG suggestive of ischemia may independently predict the likelihood of an abnormal stress test. Further validation of this model on an external dataset is necessary.

scholarly journals Derivation of a clinical decision rule for chest radiography in emergency department patients with chest pain and possible acute coronary syndrome

CJEM ◽  
2010 ◽  
Vol 12 (02) ◽  
pp. 128-134 ◽  
Author(s):  
Erik P. Hess ◽  
Jeffrey J. Perry ◽  
Pam Ladouceur ◽  
George A. Wells ◽  
Ian G. Stiell
Keyword(s):  
Heart Failure ◽  
Emergency Department ◽  
Congestive Heart Failure ◽  
Chest Pain ◽  
Chest Radiography ◽  
Clinical Decision ◽  
Chest Radiographs ◽  
Clinical Decision Rule ◽  
Coronary Syndrome ◽  
History Of

ABSTRACTObjective:We derived a clinical decision rule to determine which emergency department (ED) patients with chest pain and possible acute coronary syndrome (ACS) require chest radiography.Methods:We prospectively enrolled patients over 24 years of age with a primary complaint of chest pain and possible ACS over a 6-month period. Emergency physicians completed standardized clinical assessments and ordered chest radiographs as appropriate. Two blinded investigators independently classified chest radiographs as “normal,” “abnormal not requiring intervention” and “abnormal requiring intervention,” based on review of the radiology report and the medical record. The primary outcome was abnormality of chest radiographs requiring acute intervention. Analyses included interrater reliability assessment (with κ statistics), univariate analyses and recursive partitioning.Results:We enrolled 529 patients during the study period between Jul. 1, 2007, and Dec. 31, 2007. Patients had a mean age of 59.9 years, 60.3% were male, 4.0% had a history of congestive heart failure and 21.9% had a history of acute myocardial infarction. Only 2.1% (95% confidence interval [CI] 1.1%–3.8%) of patients had radiographic abnormality of the chest requiring acute intervention. The κ statistic for chest radiograph classification was 0.81 (95% CI 0.66–0.95). We derived the following rule: patients can forgo chest radiography if they have no history of congestive heart failure, no history of smoking and no abnormalities on lung auscultation. The rule was 100% sensitive (95% CI 32.0%–10.4%) and 36.1% specific (95% CI 32.0%–40.4%).Conclusion:This rule has potential to reduce health care costs and enhance ED patient flow. It requires validation in an independent patient population before introduction into clinical practice.

scholarly journals Just the Facts: Protected code blue – Cardiopulmonary resuscitation in the emergency department during the coronavirus disease 2019 pandemic

CJEM ◽  
2020 ◽  
Vol 22 (4) ◽  
pp. 431-434 ◽  
Author(s):  
Sarah McIsaac ◽  
Randy S. Wax ◽  
Brit Long ◽  
Christopher Hicks ◽  
Christian Vaillancourt ◽  
...  
Keyword(s):  
Patient Outcome ◽  
Emergency Department ◽  
Chest Pain ◽  
Cardiopulmonary Resuscitation ◽  
Emergency Medical Services ◽  
Negative Pressure ◽  
Shortness Of Breath ◽  
Code Blue ◽  
Palpable Pulse ◽  
History Of

Emergency medical services (EMS) is called for a 65-year-old man with a 1-week history of cough, fever, and mild shortness of breath now reporting chest pain. Vitals on scene were HR 110, BP 135/90, SpO2 88% on room air. EMS arrives at the emergency department (ED). As the patient is moved to a negative pressure room, he becomes unresponsive with no palpable pulse. What next steps should be discussed in order to protect the team and achieve the best possible patient outcome?

scholarly journals Incidence and impact of undisclosed cocaine use in emergency department chest pain and trauma patients

2008 ◽  
Vol 1 (3) ◽  
pp. 169-172 ◽  
Author(s):  
Guillermo Burillo-Putze ◽  
Juan María Borreguero León ◽  
Jose Antonio García Dopico ◽  
Jose Francisco Fernández Rodríguez ◽  
Maria Angeles Pérez Carrillo ◽  
...  
Keyword(s):  
Emergency Department ◽  
Chest Pain ◽  
Trauma Patients ◽  
Cocaine Use

scholarly journals Validation of a Decision Rule and Derivation of a Modified Rule to Obtain Chest Radiograph in Patients with Nontraumatic Chest Pain in the Emergency Department

2014 ◽  
Vol 2014 ◽  
pp. 1-5 ◽  
Author(s):  
Case Newsom ◽  
Rebecca Jeanmonod ◽  
Karl Weller ◽  
Nabil Boutros ◽  
Mark Reiter ◽  
...  
Keyword(s):  
Heart Failure ◽  
Emergency Department ◽  
Congestive Heart Failure ◽  
Chest Pain ◽  
Alcohol Abuse ◽  
Decision Rule ◽  
Predictive Value ◽  
Breath Sounds ◽  
History Of ◽  
Sensitivity Specificity

Objectives. We sought to validate and refine a decision rule for chest X-ray (CXR) utilization in nontraumatic chest pain (CP) patients presenting to the emergency department (ED). Methods. Retrospective review of ED patients presenting with CP who had CXR performed during three nonconsecutive months was performed. The presence of 18 variables derived from history and exam was ascertained. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the original rule were calculated. Refinement using additional variables was performed. Results. 967 patient charts were reviewed. 89.9% of CXR were normal, 5.2% had insignificant findings, and 5.1% had significant findings. Application of the criteria had a sensitivity/specificity of 74%/59% and a PPV/ NPV of 9%/98%. Rule modification to obtain CXR for age ≥ 65 years, history of congestive heart failure and alcohol abuse, and exam findings of decreased breath sounds, fever, and tachypnea maintained sensitivity while improving specificity to 69%. Conclusions. Most CP patients have normal CXRs. Narrowing a decision rule to obtain CXR in patients with age ≥ 65 years, history of congestive heart failure and alcohol abuse, and exam findings of decreased breath sounds, fever, and tachypnea maintain sensitivity while improving specificity and NPV.

scholarly journals Emergency Department Visits and Subsequent Hospital Admission Trends for Patients with Chest Pain and a History of Coronary Artery Disease

2020 ◽  
Vol 9 (1) ◽  
pp. 153-165 ◽  
Author(s):  
Christine Eichelberger ◽  
Aarti Patel ◽  
Zhijie Ding ◽  
Christopher D. Pericone ◽  
Jennifer H. Lin ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Emergency Department ◽  
Chest Pain ◽  
Coronary Artery ◽  
Hospital Admission ◽  
Emergency Department Visits ◽  
History Of ◽  
Artery Disease

Fatal intra-hepatic haemorrhage presenting with cardiac-type chest pain and anaemia

2007 ◽  
Vol 6 (3) ◽  
pp. 124-125
Author(s):  
Lakshmanan Sekaran ◽  
◽  
John Ho ◽  
Keyword(s):  
Myocardial Infarction ◽  
Emergency Department ◽  
Chest Pain ◽  
Recent Change ◽  
Bowel Habit ◽  
Short History ◽  
Accident And Emergency ◽  
History Of ◽  
Prosthetic Mitral Valve ◽  
Accident And Emergency Department

A 79-year-old woman presented to the accident and emergency department with a short history of central chest pain radiating to the arm and epigastrum, associated with vomiting. There was no history of haematemesis and no recent change of bowel habit or melaena. She had a myocardial infarction 4 months previously and had a metal prosthetic mitral valve replacement for which she was anticoagulated with warfarin, maintaining an INR between 2.5– 3.5. On examination she appeared pale, but there were no other abnormal findings; the liver was not enlarged or tender.

scholarly journals Woman with dyspnea and history of systemic lupus erythematosus

2021 ◽  
Vol 2 (4) ◽  
Author(s):  
Nicolas Kahl ◽  
◽  
Sukhdeep Singh ◽  
Jessica Oswald ◽  
◽  
...  
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Emergency Department ◽  
Chest Pain ◽  
Lupus Erythematosus ◽  
Lower Leg ◽  
Shortness Of Breath ◽  
Pleuritic Chest Pain ◽  
Systemic Lupus ◽  
Blood Clots ◽  
History Of

32-year-old woman with history of pleurisy and systemic lupus erythematosus presented to the emergency department with shortness of breath and pleuritic chest pain, acutely worse over one day after a six hour flight three days prior. She became dyspneic walking from her hotel bed to the bathroom. She endorsed 3 weeks of right lower leg cramping. She denied history of blood clots. She appeared tachypneic and speaking in short phrases upon arrival. A bedside ultrasound was performed, see Figures. Vitals: T: 98.3 F, HR: 130, BP: 142/88, RR: 24, oxygen saturation 97% on room air.

Sign in / Sign up

Export Citation Format

Share Document