Ischemia-Modified Albumin Improves the Usefulness of Standard Cardiac Biomarkers for the Diagnosis of Myocardial Ischemia in the Emergency Department Setting

Cardiac biomarkers have been emphasized as central to the diagnosis and risk stratification strategy for AMI by numerous clinical practice guidelines. Aim: To assess the diagnostic value of Ischemia -modified albumin (IMA) with standard biomarkers (CK-MB, LDH, and AST) troponin I [cTnI] in the early diagnosis of cardiac ischemia. Method: This is cross-sectional study was done 150 with patient’s acute chest pain as target population patients attending to the emergency department of Al Shab Hospital Khartoum. Every case was reviewed by a cardiologist. A clinical diagnosis of ischemia was assigned and correlated with biomarker test results. Results: 127 (84.7%) had myocardial ischemia. Receiver operating characteristic curves demonstrated IMA as highly sensitive but somewhat low specific for the presence of ischemia (area under curve, 0.878; P = .00). With a cut point of 88.16 U/mL, the IMA test had 84.6% sensitivity and 81% specificity for diagnosing ischemia and a negative predictive value of 77.9%. IMA was positive in 127 of 96 patients with electrocardiographic (ECG) evidence of ischemia and 31 of 127 patients with coronary ischemia but negative ECG. Among the same patients, the ECG and cTnI triad had a sensitivity of 64% and 24% respectively. The combination of IMA and ECG increased the sensitivity to (94.5%), and IMA, ECG, cTnI to 95.8%for detecting ischemia. IMA is highly sensitive and has a high negative predictive value, which might improve the usefulness of standard biomarkers of myocardial ischemia. Conclusion: Ischemia Modified Albumin has evaluated as highly sensitive, early diagnostic marker of among acute chest pain patients.

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Management of Pleural Effusions in the Emergency Department.

Reviews on Recent Clinical Trials ◽

10.2174/1574887115666200624194457 ◽

2020 ◽

Vol 15 ◽

Author(s):

MT Congedo ◽

GM Ferretti ◽

D Nachira ◽

MA Pennisi

Keyword(s):

Emergency Department ◽

Systematic Approach ◽

Acute Chest Pain ◽

Pleural Effusions ◽

Therapeutic Approaches ◽

Massive Pleural Effusion ◽

Emergency Department Setting ◽

Clinical Conditions ◽

Definitive Management

Background: In symptomatic patients, admitted in emergency department for acute chest pain and dyspnea, who require an urgent treatment, a rapid diagnosis and prompt management of massive pleural effusion or hemothorax can be lifesaving. The aim of this review was to summarize the current diagnostic and therapeutic approaches for the management of the main types of pleural effusions that physicians can have in an emergency department setting. Methods: Current literature about the topic was reviewed and critically reported, adding the experience of the authors in the management of pleural effusions in emergency settings. Results: The paper analyzed the main types of pleural effusions that physicians can have to treat. It illustrated the diagnostic steps by the principal radiological instruments, with a particular emphasis to the role of ultrasonography, in facilitating diagnosis and guiding invasive procedures. Then, the principal procedures, like thoracentesis and insertion of small and large bore chest drains, are indicated and illustrated according to the characteristics and the amount of the effusion and patient clinical conditions. Conclusion: The emergency physician must have a systematic approach that allows rapid recognition, clinical cause identification and definitive management of potential urgent pleural effusions.

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42.17 RECONSIDERING DETERMINANTS OF BRIEF INTERVENTIONS IN SUBSTANCE ABUSE TREATMENT WITHIN AN EMERGENCY DEPARTMENT SETTING

Journal of the American Academy of Child & Adolescent Psychiatry ◽

10.1016/j.jaac.2020.08.336 ◽

2020 ◽

Vol 59 (10) ◽

pp. S228

Author(s):

Ainsley Backman ◽

Courtney Lincoln ◽

Richard Steward

Keyword(s):

Emergency Department ◽

Substance Abuse ◽

Substance Abuse Treatment ◽

Brief Interventions ◽

Emergency Department Setting ◽

Abuse Treatment

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Use of Ophthalmic Sonography to Evaluate for Intraocular Foreign Body in Both Outpatient and Emergency Department/Urgent Care Patients

Journal of Diagnostic Medical Sonography ◽

10.1177/87564793211033232 ◽

2021 ◽

pp. 875647932110332

Author(s):

Patrick J. Fish

Keyword(s):

Emergency Department ◽

Foreign Body ◽

Foreign Bodies ◽

Outpatient Setting ◽

Intraocular Foreign Body ◽

Urgent Care ◽

Posterior Chamber ◽

Emergency Department Setting ◽

Before And After ◽

Glass Metal

Intraocular foreign bodies (IOFB) present differently depending on the type of material (wood, glass, metal) for the IOFB, extent of the injury, and location of the injury. IOFB and the injury can cause a perforation or penetration of the globe which can require more extensive treatment including surgery. Proper evaluation of the IOFB and injury can help to determine extent of the injury, the prognosis of the vision, and health of the eye before and after treatment but may be difficult for the physician depending on the view of the posterior chamber being compromised by media or simply by patient sensitivity. The extent of the injury may also prevent proper evaluation due to swelling, lacerations on the lids, or pain. Proper ophthalmic sonography can provide a quick evaluation of the globe for any IOFB in both the outpatient setting as well as emergency department setting. Evaluation via sonography may allow the physician to accurately diagnose and properly treat the patient to help restore and prevent further loss of vision.

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