Subject(s)
Emergency Service, Hospital , Hypertension/prevention & control , Patient Education as Topic , Secondary Prevention/methods , Echocardiography , Female , Heart Diseases/diagnosis , Humans , Longitudinal Studies , Male , Mass Screening/methods , Middle Aged , Pilot Projects , Urban Health/statistics & numerical dataABSTRACT
A 27-year-old man presented to the ED with an expanding neck mass after a Valsalva maneuver during sexual intercourse. This patient was found to have sustained a spontaneous rupture of the common carotid artery with pseudoaneurysm formation. The defect was repaired surgically with a saphenous vein patch, and the patient recovered. We discuss the rare occurrence of spontaneous carotid artery rupture and subsequent pseudoaneurysm.
Subject(s)
Aneurysm, False/etiology , Carotid Artery Diseases/complications , Carotid Artery Diseases/etiology , Adult , Aneurysm, False/diagnostic imaging , Carotid Artery Diseases/diagnostic imaging , Carotid Artery, Common/diagnostic imaging , Humans , Male , Rupture, Spontaneous , Tomography, X-Ray ComputedABSTRACT
Two cases of epidural abscess in afebrile intravenous drug abusers are presented. Both patients presented for evaluation of back pain that developed only after having moved heavy household items. One patient admitted to not having used intravenous drugs in at least 2 years. These cases are presented to illustrate the atypical fashion in which epidural abscess may present.
Subject(s)
Abscess/etiology , Back Pain/microbiology , Spinal Diseases/etiology , Staphylococcal Infections/etiology , Substance Abuse, Intravenous/complications , Abscess/diagnosis , Adult , Epidural Space , Humans , Magnetic Resonance Imaging , Male , Middle Aged , Paraplegia/microbiology , Spinal Diseases/diagnosis , Staphylococcal Infections/diagnosisABSTRACT
OBJECTIVES: To study the frequency of medical complaints and need for routine ED medical, laboratory, and toxicologic clearance for patients presenting with psychiatric chief complaints. METHODS: A retrospective, observational analysis of psychiatric patients seen in an urban teaching hospital ED over a 2-month period was performed. The individual sensitivities of history, physical examination, vital signs, and complete blood counts and chemistry panels for identifying medical problems were determined. The sensitivities and predictive values of patient self-reporting of recent illicit drug and ethanol use were also determined. RESULTS: 352 patients were seen with psychiatric chief complaints. A complete data set was available for 345 patients (98%). Of those with complete data, 65 (19%) had medical problems of any type. History, physical examination, vital signs, and laboratory testing had sensitivities of 94%, 51%, 17%, and 20%, respectively, for identifying these medical problems. Screening without universal laboratory testing would have missed 2 asymptomatic patients with mild hypokalemia. Patient self-reporting had a 92% sensitivity, a 91% specificity, an 88% positive predictive value (PPV), and a 94% negative predictive value (NPV) for identifying those with a positive drug screen, and a 96% sensitivity, an 87% specificity, a 73% PPV, and a 98% NPV for identifying those with a positive ethanol level. CONCLUSION: The vast majority of medical problems and substance abuse in ED psychiatric patients can be identified by initial vital signs and a basic history and physical examination. Universal laboratory and toxicologic screening of all patients with psychiatric complaints is of low yield.
