The aim of this case report is to present a case of a 24-year old male patient with known cholelithiasis who was presented to the emergency department with acute calculous cholecystitis. The patient was initially in sinus rhythm, but during observation converted into a complete heart block. A temporary heart pacemaker was inserted prior to an emergency laparoscopic cholecystectomy. Postoperatively, the patient converted back to sinus rhythm and made a complete recovery. Considering the patient's age, normal cardiac workup and that his arrhythmia disappeared after the removal of his gallbladder, it was postulated that this patient had a case of cardio-biliary reflex. Special attention must be given to patients with acute cholecystitis and electrocardiographic changes. Acute cholecystitis is a treatable cause of a newly diagnosed atrioventricular block, thus immediate cholecystectomy should not be deferred.
Aim To determine the effect of outpatient oral antibiotics on coronavirus disease 2019 (COVID-19) in patients presenting to the emergency department. Methods This retrospective cohort study with propensity score matching conducted at University Hospital Dubrava collected data on all emergency department visits due to COVID-19 in November 2020. The primary outcome was hospital admission. The secondary outcomes were pneumonia development, respiratory failure, and required level of respiratory support. Results Overall, 1217 visits were evaluated and 525 patients were included in the analysis. After propensity score matching, 126 pairs of treated patients and controls were identified. Patients and controls did not differ in physical examination findings, laboratory test results, radiographic findings, or defined outcomes before and after matching. Conclusion This study suggests no benefit of empirical oral antibiotics for outpatient treatment of COVID-19. In patients presenting to the emergency department, prior oral antibiotic treatment did not affect hospital admission rates or the level of respiratory support required.
We reported a case of a former water polo player who suffered from a non-traumatic right subclavian vein thrombosis. An otherwise healthy former athlete developed thrombosis of the right subclavian vein. He presented with swelling of his right arm. Diagnosis was made by colour doppler ultrasonography. He received low molecular weight heparin as initial treatment followed by thrombolytic therapy with alteplase and heparin infusion. He continued with outpatient anticoagulant therapy for six months before returning to usual daily activities. There is no evidence or report on the time length after ending of an athletic pursuit that would predispose to the formation of subclavian vein thrombosis. Early diagnosis and treatment of patients with subclavian vein thrombosis is important in order to avoid complications, occupational disability and the adverse impact on the patient's quality of life.
The common iliac artery aneurysms are rare and usually present in patients with abdominal aortic aneurysms. They are most commonly asymptomatic and the clinical symptoms are non-specific, including abdominal pain, genitourinary symptoms, back pain and sciatica. The rupture usually causes haemodynamic instability and carries a high mortality rate. We describe an elderly patient presenting with abdominal pain and fever who had a pulsating mass in the lower right quadrant of the abdomen, diagnosed via point-of-care ultrasound. The definite diagnosis was made with computed tomography and the patient was urgently transferred to the surgery department.
Patient management in the emergency department (Ed) is evaluated by performance indicators, such as wait times (time to be seen by a physician), length of stay (lOS) and the number of diagnostic tests per patient. to improve the quality of care, dedicated emergency medicine (Em) specialists are employed to work in the Ed. The aim of this study is to evaluate three performance indicators of patient management in the Ed compared by specialty, internal medicine (Im) versus Em. research was conducted in the Ed of a large tertiary teaching hospital. A retrospective data analysis of the hospital information system was conducted for the period when only Im specialists were working as attendants, versus a period when two Em specialists joined the Ed team. We calculated the percentage of patients seen within the recommended time per Australasian triage system (ASt) category and compared the average lOS and the average number of tests per patient, using data from June 2017 to January 2020. means, standard deviation, standard error, 95% confidence interval were calculated, and the independent t-test was used to compare means. With the introduction of the Em specialists, the percentage of patients examined within the recommended time frame per ASt category was higher. There was a significant reduction in lOS in the Ed when comparing only Im specialists to Im specialists with two Em specialists (p<0.001). The Im physicians on average do more tests than Em specialists, which was statistically significant (p<0.05). There was a significant improvement in efficiency in the Ed with the introduction of Em specialists which was manifested by shorter patient wait times and shorter length of stay in the Emergency department and fewer diagnostic test orders.
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