CJEM最新文献

Background: ECGs performed at ED triage are mandatorily assessed by an emergency physician contributing to task interruptions, decreased quality of care and increased error risk. Recent literature suggests that a triage ECG interpreted as normal by the ECG machine software correlates with benign interpretation from attending cardiologists. Ambiguity persists regarding the safety of the normal computerized ECG interpretation and whether real-time physician review is needed.

Methods: In this prospective cohort study, we evaluated the GE Marquette 12SL ECG software's clinical accuracy for normal triage ECGs. We compared machine interpretation, ED physicians' real-time interpretation and management as well as cardiologists systematic but delayed review of the ECGs to establish diagnostic accuracy and safety of a normal software interpretation. Additional data were collected from the emergency department patient tracking system and charts to determine patient outcomes when machine normal interpretation differed from ED physicians and cardiologists' analysis.

Results: Between November 16th 2020 and November 19th 2021, we collected 1220 machine-normal ECGs performed at Charles-Le Moyne Hospital ED triage. 1051 ECGs were eligible for inclusion. ED physicians agreed with the machine for 1028 normal diagnoses (97.8% IC (0.95): 96.7-98.5) and cardiologists agreed with the machine for 1037 ECGs (98.7% IC (0.95) 97.8-99.2). Relevant changes in ED management were recorded in three patients (0.29% IC (0.95): 0.1-0.8) whose ECGs were read as normal by the software: two emergent referrals to the catheterization lab and one emergent transfer to the resuscitation bay with next day coronarography.

Conclusion: A normal ECG interpretation from the GE Marquette 12SL ECG software at ED triage has a very high accuracy and a very low probability of clinically relevant change in patient outcome and ED trajectory.

Introduction: Nonconvulsive status epilepticus is a severe complication of lithium intoxication that requires prompt diagnosis and treatment. While conventional electroencephalography (EEG) remains the gold standard for diagnosis for nonconvulsive status epilepticus, its implementation in emergency settings can be challenging and time-consuming. We present a case in which simplified EEG with six electrodes enabled rapid detection and monitoring of nonconvulsive status epilepticus in lithium intoxication in the emergency setting.

Case presentation: A 65-year-old woman with stable bipolar disorder presented to our emergency department with impaired consciousness. She had been maintained on lithium carbonate (1600 mg daily) and carbamazepine (400 mg daily) for over 10 years. Following two weeks of nausea and recent onset of agitation and slurred speech, she developed generalized convulsions. Laboratory examinations revealed elevated serum lithium (3.88 mEq/L) and acute renal dysfunction (creatinine 347.5 μmol/L). After resolving initial convulsions, a simplified sixelectrode EEG (Neurofax EEG-1250, Nihon Kohden Corporation, Tokyo, Japan), applied by an emergency physician, demonstrated generalized spike and wave patterns consistent with nonconvulsive status epilepticus. Despite initial seizure control with midazolam during intubation, continuous EEG monitoring revealed recurrent nonconvulsive status epilepticus. After hemodialysis and continued deep sedation, she was discharged on day 40 without neurological sequelae.

Discussion: This case demonstrates the utility of simplified EEG in emergency settings for early detection and monitoring of nonconvulsive status epilepticus in lithium intoxication. The ability of emergency physicians to apply and interpret simplified EEG enabled timely intervention and prevention of neurological complications. While further research is needed to validate interpretation protocols by non-EEG specialists, simplified EEG shows promise as an accessible tool for rapid assessment of neurotoxicity in lithium intoxication, potentially improving patient outcomes through earlier intervention.