Visual hallucination as presenting symptom for acute parieto-occipital cerebrovascular accident.

Visual hallucinations are visual perceptions that are not associated with a real object. Visual hallucinations are often associated with dementia, eye disease, visual pathway disease, psychiatric disorders, delirium, migraines, ictal phenomena, or medication effects. We report a case of a 74-year-old woman with a previous cerebrovascular accident(CVA) without residual deficit and no previous psychiatric history presenting for one week of worsening hallucinations progressing from shapes to cats to human figures in the left visual field.

Identifying patients with cellulitis who are likely to require inpatient admission after a stay in an ED observation unit.

Background: Emergency department observation units (EDOU) are often used for patients with cellulitis to provide intravenous antibiotics followed by a transition to an oral regimen for discharge. Because institutional regulations typically limit EDOU stays to 24 hours, patients lacking a clinical response within this period will often be subsequently admitted to the hospital for further treatment.

Objective: The aim of this study was to determine the rate of hospital admission and characteristics predictive of admission in patients with cellulitis who are initially placed in an ED observation unit.

Prevalence of bicycle helmet use by users of public bikeshare programs.

Study Objective: Public bikeshare programs are becoming increasingly common in the United States and around the world. These programs make bicycles accessible for hourly rental to the general public. We seek to describe the prevalence of helmet use among adult users of bikeshare programs and users of personal bicycles in 2 cities with recently introduced bikeshare programs (Boston, MA, and Washington, DC).

Should creatine kinase-MB index be eliminated in patients with indeterminate troponins in the ED?

Objectives: The objective of this study is to determine whether creatine kinase-MB (CK-MB) index (CK-MBi) is useful in the evaluation of acute myocardial infarction (AMI) in patients with indeterminate troponin (Tn) in the emergency department (ED).

Methods: A retrospective cohort study was conducted of patients at an urban academic ED with over 55 000 annual visits who underwent Tn T (Roche, Indianapolis, IN) and CK-MB testing. One year of ED patients who had Tn testing were identified, and their corresponding CK-MBi was examined to find patients with indeterminate Tn (0.

Effect of two different FDA-approved D-dimer assays on resource utilization in the emergency department.

Background: The D-dimer assay has been shown to be an appropriate test to rule out pulmonary embolism (PE) in low-risk patients in the emergency department (ED). Multiple assays now are approved to measure D-dimer levels. Studies have shown a newer assay, Tina-quant, to have similar diagnostic accuracy to the VIDAS assay.

Creatine kinase-MB does not add additional benefit to a negative troponin in the evaluation of chest pain.

Objective: The aim of this study was to determine whether current troponin assay alone can be used for initial screening for acute myocardial infarction (AMI) and whether creatine kinase-MB (CK-MB) can safely be eliminated from this evaluation in the emergency department (ED).

Methods: A retrospective cohort study of patients who had cardiac troponin T (Roche, Basel, Switzerland) and CK-MB ordered at an urban academic level 1 trauma center with more than 55,000 annual visits. Patients with troponin testing in the ED were identified over a period of 12 months, and corresponding CK-MB indexes were examined identifying patients with negative troponins (<0.

Eliminating amylase testing from the evaluation of pancreatitis in the emergency department.

Background: Alterations in serum biomarkers have been used to evaluate for pancreatitis in the emergency department (ED). Studies have shown lipase to be as sensitive and more specific than amylase in diagnosing pancreatitis and that amylase plus lipase does not improve accuracy over lipase alone.

Objective: To determine effects of interventions to decrease ordering of amylase in the evaluation of pancreatitis.