Rhabdomyolysis, Methamphetamine, Amphetamine and MDMA Use: Associated Factors and Risks.

Rhabdomyolysis is associated with methamphetamine, amphetamine, and methylenedioxymethamphetamine (MA) use. The aim of this study was to determine the frequency, severity, and risk factors of rhabdomyolysis associated with MA use. We reviewed patients with an MA-positive toxicology screen with and without diagnosed rhabdomyolysis based on initial creatine kinase (CK) concentration over a period of 6 years.

Methamphetamine use and heart failure: Prevalence, risk factors, and predictors.

Objectives: To compare methamphetamine users who develop heart failure to those who do not and determine predictors.

Methods: Patients presenting over a two-year period testing positive for methamphetamine on their toxicology screen were included. Demographics, vital signs, echocardiography and labs were compared between patients with normal versus abnormal B-type natriuretic peptide (BNP).

Methamphetamine Use and Emergency Department Utilization: 20 Years Later.

Background: Methamphetamine (MAP) users present to the emergency department (ED) for myriad reasons, including trauma, chest pain, and psychosis. The purpose of this study is to determine how their prevalence, demographics, and resource utilization have changed.

Methods: Retrospective review of MAP patients over 3 months in 2016.

Acute Medical Diagnoses Are Common in "Found Down" Adult Patients Presenting to the Emergency Department as Trauma.

Background: Patients often present to the emergency department (ED) as "found down," with limited history to suggest a primary traumatic or medical etiology.

Objective: The study objective was to describe the characteristics of "found down" adult patients presenting to the ED as trauma, specifically the incidence of acute medical diagnoses and major trauma.

Methods: Using an institutional trauma registry, we reviewed trauma activations with the cause of injury "found down" between January 2008 and December 2012.

Characteristics of the pediatric patients treated by the Pediatric Emergency Care Applied Research Network's affiliated EMS agencies.

Objective: To describe pediatric patients transported by the Pediatric Emergency Care Applied Research Network's (PECARN's) affiliated emergency medical service (EMS) agencies and the process of submitting and aggregating data from diverse agencies.

Methods: We conducted a retrospective analysis of electronic patient care data from PECARN's partner EMS agencies. Data were collected on all EMS runs for patients less than 19 years old treated between 2004 and 2006.

Value of high-sensitivity C-reactive protein in low risk chest pain observation unit patients.

Objective: High-sensitivity C-reactive protein (hs-CRP) rises with cardiac injury/ischemia. We evaluated its efficacy in aiding in the identification of an acute coronary syndrome (ACS) in patients (pts) admitted to the chest pain unit (CPU) for possible ACS.

Methods: Retrospective study of all patients admitted to the CPU with chest pain who underwent hs-CRP testing as part of their CPU evaluation from January 2004 to October 2008.

Relationship of myocardial ischemia and injury to coronary artery disease in patients with supraventricular tachycardia.

Increase of serum troponin I and ST-segment depression are objective markers of myocardial ischemia/injury. Abnormalities of the 2 indicators have been associated with supraventricular tachycardia (SVT) but their relevance for diagnosing acute coronary syndrome and the presence of coronary artery disease (CAD) in this setting have not been clarified. Therefore, we sought to evaluate the frequency of CAD based on increased troponin I and ST-segment depression during SVT.

Frequency of non-ST-segment elevation injury patterns on prehospital electrocardiograms.

Introduction: Prehospital electrocardiograms (ECGs) have been recommended to facilitate early diagnosis of ST-segment elevation myocardial infarction (STEMI). However, prehospital ECGs can also be used to triage patients with non-ST-segment elevation acute coronary syndromes, who comprise a majority of patients with ischemic events presenting by ambulance to overcrowded emergency departments.

Objective: We assessed the frequency of non-ST-segment elevation injury patterns on prehospital ECGs in patients with a chief complaint of chest pain evaluated by the emergency medical services (EMS) system.

Frequency of acute coronary syndrome in patients with normal electrocardiogram performed during presence or absence of chest pain.

Objectives: The authors hypothesized that patients with active chest pain at the time of a normal electrocardiogram (ECG) have a lower frequency of acute coronary syndrome (ACS) than patients being evaluated for chest pain but with no active chest pain at the time of a normal ECG. The study objective was to describe the association between chest pain in patients with a normal ECG and the diagnosis of ACS.

Methods: This was a prospective observational study of emergency department (ED) patients with a chief complaint of chest pain and an initial normal ECG admitted to the hospital for chest pain evaluation over a 1-year period.

Use of additional electrocardiograph leads in low-risk patients undergoing exercise treadmill testing.

Background: Studies have shown that the addition of right precordial and left posterior leads to the standard 12-lead electrocardiogram (ECG) can significantly improve the sensitivity of exercise treadmill testing (ETT) for the diagnosis of myocardial ischemia.

Objective: The objective of this study was to determine the value of adding 2 rightsided (RV3, RV4) and 2 left posterior (V8, V9) auxiliary leads to enhance detection of myocardial ischemia in patients with chest pain identified as low risk.

Methods: The authors conducted a prospective study of all patients undergoing ETT as part of their management in a chest pain evaluation unit (CPEU) at a tertiary medical center from November 1999 to November 2001.

Assessing the need for functional diagnostic testing in low-risk women with chest pain.

Objective: The objective of this study was to assess the need for functional diagnostic testing to identify coronary artery disease (CAD) in women presenting with chest pain and deemed at low risk in a chest pain evaluation unit (CPEU) setting.

Methods: Low-risk women evaluated in a CPEU were defined as having < or =1 intermediate determinant of CAD (hypertension, tobacco use, or hypercholesterolemia) or < or =2 minor determinants (age, obesity, sedentary lifestyle, or family history of CAD). Patients were followed for 30 days for the occurrence of CAD, defined as a positive stress imaging study, significant CAD on angiography, myocardial revascularization, myocardial infarction (MI), or cardiac death.

Venous ultrasound testing for suspected thrombosis: incidence of significant non-thrombotic findings.

Duplex ultrasound (US) is used to "rule out" deep venous thrombosis (DVT), but can also diagnose other causes of leg pain or swelling in Emergency Department (ED) patients. Recent literature suggests that US imaging is unnecessary among patients with low or moderate clinical probability of DVT with a normal D-dimer. We attempted to determine the incidence of clinically important incidental findings detected using venous US imaging in patients with suspected lower extremity DVT.

Reporting patterns for "lapses of consciousness" by California emergency physicians.

Physician reporting of lapses of consciousness (LOC) to the Department of Motor Vehicles is a controversial topic in medicine. The objective of this study was to describe current LOC reporting practices by emergency physicians (EPs) in a state with mandatory reporting requirements (California). A questionnaire describing 14 different clinical scenarios involving LOC was distributed to a diverse sample of California EPs.

Evaluation of patients with methamphetamine- and cocaine-related chest pain in a chest pain observation unit.

Objective: Risk of acute coronary events in patients with methamphetamine and cocaine intoxication has been described. Little is known about the need for additional evaluation in these patients who do not have evidence of myocardial infarction after the initial emergency department evaluation. We herein describe our experience with these patients in a chest pain unit (CPU) and the rate of cardiac-related chest pain in this group.

Electrocardiogram differentiation of benign early repolarization versus acute myocardial infarction by emergency physicians and cardiologists.

Objectives: ST-segment elevation (STE) related to benign early repolarization (BER), a common normal variant, can be difficult to distinguish from acute myocardial infarction (AMI). The authors compared the electrocardiogram (ECG) interpretations of these two entities by emergency physicians (EPs) and cardiologists.

Methods: Twenty-five cases (13 BER, 12 AMI) of patients presenting to the emergency department with chest pain were identified.

Exercise testing in chest pain units: rationale, implementation, and results.

Chest pain units are now established centers for assessment of low-risk patients presenting to the emergency department with symptoms suggestive of acute coronary syndrome. Accelerated diagnostic protocols, of which treadmill testing is a key component, have been developed within these units for efficient evaluation of these patients. Studies of the last decade have established the utility of early exercise testing,which has been safe, accurate, and cost-effective in this setting.

Frequency of acute coronary syndrome in patients presenting to the emergency department with chest pain after methamphetamine use.

We reviewed the frequency of acute coronary syndrome (ACS) in patients presenting to our emergency department (ED) with chest pain after methamphetamine (MAP) use during a 2-year interval. Thirty-three patients (25 males, 8 females; average age 40.4 +/- 8.

Cholesterol screening in an ED-based chest pain unit.

To evaluate the prevalence of dyslipidemia in patients who are evaluated in a chest pain evaluation unit (CPEU) a prospective study of all patients admitted to our CPEU from January 1 to December 31, 1999 was conducted. Serum total cholesterol (TC) and high density lipoprotein (HDL) levels were obtained unless prior levels were known or at the discretion of the attending physician. Both TC and HDL were tested in 606 (59%) patients.

Immediate exercise testing to evaluate low-risk patients presenting to the emergency department with chest pain.

Objectives: Our purpose was to determine the safety and accuracy of immediate exercise testing in low-risk patients presenting to the emergency department (ED) with chest pain suggestive of a cardiac etiology.

Background: Safe, efficient management of low-risk patients presenting to the ED with chest pain is a continuing challenge. We have employed immediate exercise testing to evaluate a large, heterogeneous group of low-risk patients presenting with chest pain.

Acute ischemic syndromes. Chest pain center concept.

CPCs have been developed to meet the clinical challenge posed by the diverse group of patients presenting to the ED with findings suggestive of a coronary event. Using a protocol-driven approach, high- and low-risk patients can be identified on presentation, facilitating urgent therapy in the former and triage of the latter to more deliberate management. Most CPCs focus on low-risk patients who are being increasingly managed by accelerated diagnostic protocols.