Subject(s)
Optic Neuritis , Emergency Service, Hospital , Follow-Up Studies , Humans , Optic Neuritis/diagnosis , UltrasonographyABSTRACT
BACKGROUND: Transorbital ultrasound was used to diagnose acute optic neuritis (AON) at bedside in an emergency department (ED). CASE REPORT: A 59-year-old female patient presented to an ED after 7 days of progressive unilateral visual loss while she was receiving outpatient treatment for relapsing-remitting multiple sclerosis. Transorbital ultrasound revealed a disparity between the optic nerve sheath diameters of the affected and nonaffected eyes and striking optic nerve edema in the affected eye. These findings led to a diagnosis of AON and early definitive treatment. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Given an absence of reliable diagnostic criteria for AON, comorbidity with multiple sclerosis, and limitations inherent to magnetic resonance imaging, transorbital sonography may facilitate diagnosis of this condition in emergent presentations.
Subject(s)
Optic Neuritis/diagnostic imaging , Ultrasonography/methods , Blindness/diagnostic imaging , Blindness/etiology , Emergency Service, Hospital/organization & administration , Female , Headache/diagnostic imaging , Headache/etiology , Humans , Middle Aged , Optic Neuritis/diagnosis , Point-of-Care SystemsABSTRACT
Acute asthma and chronic obstructive pulmonary disease (COPD) exacerbations are the most common respiratory diseases requiring emergent medical evaluation and treatment. Asthma and COPD are chronic, debilitating disease processes that have been differentiated traditionally by the presence or absence of reversible airflow obstruction. Asthma and COPD exacerbations impose an enormous economic burden on the US health care budget. In daily clinical practice, it is difficult to differentiate these 2 obstructive processes based on their symptoms, and on their nearly identical acute treatment strategies; major differences are important when discussing anatomic sites involved, long-term prognosis, and the nature of inflammatory markers.
Subject(s)
Airway Management/methods , Asthma/diagnosis , Asthma/therapy , Emergency Service, Hospital , Pulmonary Disease, Chronic Obstructive/diagnosis , Pulmonary Disease, Chronic Obstructive/therapy , Acute Disease , Adrenal Cortex Hormones/therapeutic use , Anti-Bacterial Agents/therapeutic use , Bronchodilator Agents/therapeutic use , Disease Management , Disease Progression , Dyspnea/diagnosis , Dyspnea/therapy , Humans , Respiration, Artificial/methodsABSTRACT
BACKGROUND: Diltiazem (calcium channel blocker) and metoprolol (beta-blocker) are both commonly used to treat atrial fibrillation/flutter (AFF) in the emergency department (ED). However, there is considerable regional variability in emergency physician practice patterns and debate among physicians as to which agent is more effective. To date, only one small prospective, randomized trial has compared the effectiveness of diltiazem and metoprolol for rate control of AFF in the ED and concluded no difference in effectiveness between the two agents. OBJECTIVE: Our aim was to compare the effectiveness of diltiazem with metoprolol for rate control of AFF in the ED. METHODS: A convenience sample of adult patients presenting with rapid atrial fibrillation or flutter was randomly assigned to receive either diltiazem or metoprolol. The study team monitored each subject's systolic and diastolic blood pressures and heart rates for 30 min. RESULTS: In the first 5 min, 50.0% of the diltiazem group and 10.7% of the metoprolol group reached the target heart rate (HR) of <100 beats per minute (bpm) (p < 0.005). By 30 min, 95.8% of the diltiazem group and 46.4% of the metoprolol group reached the target HR < 100 bpm (p < 0.0001). Mean decrease in HR for the diltiazem group was more rapid and substantial than that of the metoprolol group. From a safety perspective, there was no difference between the groups with respect to hypotension (systolic blood pressure < 90 mm Hg) and bradycardia (HR < 60 bpm). CONCLUSIONS: Diltiazem was more effective in achieving rate control in ED patients with AFF and did so with no increased incidence of adverse effects.
