The American journal of emergency medicine
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Unilateral paralysis is rarely reported to be primary presentation of severe hypokalemia. We describe a 24-year-old woman who presented to the emergency department with sudden onset of right-sided weakness. Neurologic examination revealed diminished muscle strength and tendon reflexes over the right limbs. ⋯ However, laboratory data showed hypokalemia (K+ 2.0 mmol/L) with metabolic acidosis (HCO3 − 19 mmol/L). She needed a total of 260 mmol K+ to achieve complete recovery of muscle strength at a serum K+ level of 3.2 mmol/L and was proved to have distal renal tubular acidosis. Severe hypokalemia must be kept in mind as a cause of acute unilateral paralysis without organic lesions to avoid unnecessary examination and potentially life-threatening complications.
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Gastric rupture is a rare complication after cardiopulmonary resuscitation (CPR). In most cases, incorrect management of airways during CPR is the main cause. ⋯ He eventually presented with bloody vomitus and a tympanic abdomen. When faced with a patient with abdominal signs post-CPR, surgical complications of CPR should be considered.
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Neck pain is a common cause for presentation to an emergency department. Most causes are benign and often secondary to arthritis or injuries. ⋯ Consequences may be severe and include joint destruction and infection progression. Symptoms may be indolent, and a high index of suspicion is necessary to make this diagnosis.
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We describe our preliminary experience with coronary computed tomography angiography (CCTA) in emergency department (ED) patients with low- to intermediate-risk chest pain. ⋯ Many ED patients with low- to intermediate-risk chest pain have a normal or nonobstructive CCTA and may be safely discharged from the ED without any associated mortality within the following 6 months.
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The HEART score uses elements from patient History, Electrocardiogram, Age, Risk Factors, and Troponin to obtain a risk score on a 0- to 10-point scale for predicting acute coronary syndromes (ACS). This investigation seeks to improve on the HEART score by proposing the HEARTS(3) score, which uses likelihood ratio analysis to give appropriate weight to the individual elements of the HEART score as well as incorporating 3 additional "S" variables: Sex, Serial 2-hour electrocardiogram, and Serial 2-hour delta troponin during the initial emergency department valuation. ⋯ The HEARTS(3) score reliably risk stratifies patients with chest pain for 30-day ACS. Prospective studies need to be performed to determine if implementation of this score as a decision support tool can guide treatment and disposition decisions in the management of patients with chest pain.