scholarly journals Efficacy of bedside ultrasonography in early diagnosis of patients admitted to the emergency department with dyspnea

Critical Care ◽  
2010 ◽  
Vol 14 (Suppl 1) ◽  
pp. P271
Author(s):  
E Dogan ◽  
S Girisgin ◽  
D Dündar ◽  
B Cander
Keyword(s):  
Emergency Department ◽  
Early Diagnosis ◽  
Bedside Ultrasonography

An Unusual Case of Pelvic Appendicitis

PEDIATRICS ◽  
1976 ◽  
Vol 58 (2) ◽  
pp. 292-293
Author(s):  
Michael A. LaCombe
Keyword(s):  
Emergency Department ◽  
Case Report ◽  
Early Diagnosis ◽  
Unusual Case ◽  
Signs And Symptoms ◽  
Memorial Hospital ◽  
Pubic Bone ◽  
Bowel Habit ◽  
Gross Hematuria ◽  
Misleading Interpretation

The atypical signs and symptoms, the misleading interpretation of symptoms by the patient's family, and the remarkable radiograph in the following case emphasize the difficulty in early diagnosis of pelvic appendicitis. CASE REPORT A 10-year-old boy came to the Emergency Department of Community Memorial Hospital, Toms River, New Jersey, complaining of pain in the pubic bone of four hours' duration. His mother thought he might have fallen on the cross-bar of his bike and was concerned about a possible fracture of the pelvis. The boy denied any nausea, vomiting, anorexia, or change in bowel habit and had no pain elsewhere. He had noticed no gross hematuria.

scholarly journals The relevance of a fast and early diagnosis of necrotizing fasciitis in the Emergency Department: a case report

2016 ◽  
Vol 10 ◽  
Author(s):  
Marianna Gregorio ◽  
Antonio Villa
Keyword(s):  
Diabetes Mellitus ◽  
Emergency Department ◽  
Case Report ◽  
Early Diagnosis ◽  
Necrotizing Fasciitis ◽  
Multiorgan Failure ◽  
Left Thigh ◽  
Popliteal Fossa ◽  
Leg Pain ◽  
Movement Limitation

We report a case of necrotizing fasciitis in an 84 year-old man affected by diabetes mellitus. The patient was admitted in the Emergency Department of our hospital because of an acute and strong left leg pain that began almost 8 hours before admission. The left leg had an increased size and a movement limitation, with a hard haemathoma in the left thigh with subcutaneous crepitus. The lesion became worse and larger rapidly, with a wide extension from the back to the popliteal fossa. An antimicrobial therapy was immediately started with morphine for pain. A surgical debridment was performed, but the patient died for multiorgan failure. Necrotizing fasciitis is a rare and mortal disease, the early diagnosis is a challenge for the Emergency Department where patients are admitted and assessed primarly.

scholarly journals A Study on Shock Index in Early Diagnosis of Sepsis in Emergency Department of Tertiary Care Centre of Nepal

2019 ◽  
Vol 2 (2) ◽  
pp. 37-42
Author(s):  
Manish Nath Pant ◽  
Subash Dawadi ◽  
Ashish Thapa
Keyword(s):  
Emergency Department ◽  
Heart Rate ◽  
Severe Sepsis ◽  
Early Diagnosis ◽  
Blood Lactate ◽  
Lactate Level ◽  
Tertiary Care ◽  
Serum Lactate ◽  
Shock Index ◽  
Tertiary Care Centre

Introduction: Sepsis and its consequences, severe sepsis and septic shock is at menace in country like ours where infectious disease are at toll. Early diagnosis and treatment is very important to decrease the morbidity and mortality. Shock index is one of such tool that is very handy in these situations as this is just a mathematical calculation using heart rate(HR) and systolic blood pressure(SBP). The main aim of this study was to find the effectiveness of using SI as an adjunct to blood lactate in diagnosing patients in sepsis. Methods: This was an observational hospital-based study conducted at Emergency Department of TUTH, Maharajgunj on 104 patients, obtained by purposive sampling method, who had presented to the “Red Area”, aged between 18 to 65 years. These patients were screened for severe sepsis using triage vital signs, basic laboratory tests and an initial serum lactate level. Test characteristics were calculated for hyperlactatemia. I considered the following covariates in our analysis: heart rate >90 beats/min; mean arterial pressure <65 mmHg; respiratory rate > 20 breaths/min; ≥2 SIRS including white blood cell count; SI <0.6; SI 0.6 to 1; SI 1 to 1.4and SI ≥ 1.4.  Results: There was a positive correlation between shock index and blood lactate level, r=0.2, n=104, p=0.042. No relationship was found between SI>=1 and hyperlactemia, X2 (.285, N = 104) = 1, p =.594 and relationship was found between SI >=0.7 and hyperlactemia, X2 (4.1, N = 104) = 1, p =.04. sensitivity and specificity for detecting hyperlactemia of SI>=1, SI.=0.7, SIRS was 84% and 20%, 93% and 0%, 79% and 20% respectively. Conclusions: There was weak correlation between the lactate level and shock index with statistically significant correlation between the shock index grouped >=0.7 and hyperlactatemia with high sensitivity and very low specificity.

Heparin Binding Protein for The Early Diagnosis and Prognosis Of Sepsis In The Emergency Department

Shock ◽  
2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Konstantinos Katsaros ◽  
Georgios Renieris ◽  
Asimina Safarika ◽  
Evangelia-Maria Adami ◽  
Theologia Gkavogianni ◽  
...  
Keyword(s):  
Emergency Department ◽  
Early Diagnosis ◽  
Binding Protein ◽  
Heparin Binding ◽  
Diagnosis And Prognosis ◽  
Heparin Binding Protein

scholarly journals Cutting-Edge Technology for Rapid Bedside Assessment of Capillary Refill Time for Early Diagnosis and Resuscitation of Sepsis

2020 ◽  
Vol 7 ◽  
Author(s):  
David C. Sheridan ◽  
Robert Cloutier ◽  
Andrew Kibler ◽  
Matthew L. Hansen
Keyword(s):  
Emergency Department ◽  
Early Diagnosis ◽  
New Technology ◽  
Cutting Edge ◽  
Adult Patients ◽  
White Blood Count ◽  
Organ Perfusion ◽  
Capillary Refill ◽  
Individualized Care ◽  
Emergency Department Triage

Sepsis currently affects over 30 million people globally with a mortality rate of ~30%. Prompt Emergency Department diagnosis and initiation of resuscitation improves outcomes; data has found an 8% increase in mortality for every hour delay in diagnosis. Once sepsis is recognized, the current Surviving Sepsis Guidelines for adult patients mandate the initiation of antibiotics within 3 h of emergency department triage as well as 30 milliliters per kilogram of intravenous fluids. While these are important parameters to follow, many emergency departments fail to meet these goals for a variety of reasons including turnaround on blood tests such as the serum lactate that may be delayed or require expensive laboratory equipment. However, patients routinely have vital signs assessed and measured in triage within 30 min of presentation. This creates a unique opportunity for implementation point for cutting-edge technology to significantly reduce the time to diagnosis of potentially septic patients allowing for earlier initiation of treatment. In addition to the practical and clinical difficulties with early diagnosis of sepsis, recent clinical trials have shown higher morbidity and mortality when septic patients are over-resuscitated. Technology allowing more real time monitoring of a patient's physiologic responses to resuscitation may allow for more individualized care in emergency department and critical care settings. One such measure at the bedside is capillary refill. This has shown favor in the ability to differentiate subsets of patients who may or may not need resuscitation and interpreting blood values more accurately (1, 2). This is a well-recognized measure of distal perfusion that has been correlated to sepsis outcomes. This physical exam finding is performed routinely, however, there is significant variability in the measurement based on who is performing it. Therefore, technology allowing rapid, objective, non-invasive measurement of capillary refill could improve sepsis recognition compared to algorithms that require lab tests included lactate or white blood count. This manuscript will discuss the broad application of capillary refill to resuscitation care and sepsis in particular for adult patients but much can be applied to pediatrics as well. The authors will then introduce a new technology that has been developed through a problem-based innovation approach to allow clinicians rapid assessment of end-organ perfusion at the bedside or emergency department triage and be incorporated into the electronic medical record. Future applications for identifying patient decompensation in the prehospital and home environment will also be discussed. This new technology has 3 significant advantages: [1] the use of reflected light technology for capillary refill assessment to provide deeper tissue penetration with less signal-to-noise ratio than transmitted infrared light, [2] the ability to significantly improve clinical outcomes without large changes to clinical workflow or provider practice, and [3] it can be used by individuals with minimal training and even in low resource settings to increase the utility of this technology. It should be noted that this perspective focuses on the utility of capillary refill for sepsis care, but it could be considered the next standard of care vital sign for assessment of end-organ perfusion. The ultimate goal for this sensor is to integrate it into existing monitors within the healthcare system.

scholarly journals Rare variant of Guillain-Barré syndrome after chikungunya viral fever

2019 ◽  
Vol 12 (4) ◽  
pp. e228845 ◽  
Author(s):  
Sajid Hameed ◽  
Sara Khan
Keyword(s):  
Emergency Department ◽  
Early Diagnosis ◽  
Symptom Onset ◽  
Complete Resolution ◽  
Neurological Complications ◽  
Acute Onset ◽  
Guillain Barre Syndrome ◽  
Ventilator Support ◽  
Guillain Barré Syndrome ◽  
Guillain Barré

Chikungunya (CHIK) viral fever is a self-limiting illness that presents with severe debilitating arthralgia, myalgia, fever and rash. Neurological complications are rare. We present a case of a 36-year-old woman who presented with acute onset progressive difficulty swallowing and left arm weakness. She was diagnosed with CHIK viral fever 4 weeks prior to admission. After investigations, she was diagnosed with a pharyngeal–cervical–brachial variant of Guillain-Barré syndrome. In hospital, she required ventilator support. Her condition improved after five sessions of intravenous immunoglobulin with almost complete resolution within 6 months of symptom onset. With frequent CHIK outbreaks, the neurological complications are increasingly seen in the emergency department. The knowledge of these associations will result in early diagnosis and treatment.

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