The American journal of emergency medicine
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Lyme carditis poses a challenge to physicians given dramatic clinical presentations like the one presented in this case. Quite frequently, these young patients are implanted with permanent pacemakers; given lack of knowledge on the transient nature of the cardiac conduction system inflammation. This is the first case in the literature that has captured the electrocardiographic evolution of Lyme carditis, day by day until complete resolution.
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With an elderly and chronically ill patient population visiting the emergency department, it is important to know patients' wishes regarding care preferences and advanced directives. Ohio law states DNR orders must be transported with the patient when they leave an extended care facility (ECF). We reviewed the charts of ECF patients to evaluate which patients presenting to the ED had their DNR status recognized by the physician and DNR orders that were made during their hospital stay. ⋯ Hospital staff did a poor job of noting DNR preferences and ECFs were inconsistent with sending Ohio DNR forms.
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Alcohol use is widespread, and withdrawal symptoms are common after decreased alcohol intake. Severe alcohol withdrawal may manifest with delirium tremens, and new therapies may assist in management of this life-threatening condition. ⋯ Alcohol withdrawal syndrome can result in significant morbidity and mortality. Physicians must rapidly diagnose these conditions while evaluating for other diseases. Benzodiazepines are the predominant medication class utilized, with adjunctive treatments including propofol or phenobarbital in patients with withdrawal resistant to benzodiazepines. Dexmedetomidine and ketamine require further study.
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Characteristic ECG changes with hypercalcemia include shortening of the QoT, QaT, and QeT intervals which are measured from the beginning of the QRS complex to the origin (O), apex (A), and end (E) of the T wave respectively. At very high serum calcium levels ECG changes include slight prolongation of the PR and QRS intervals, T wave flattening or inversion, and the appearance of a J wave at the end of the QRS complex. ⋯ Cardiac troponin testing was negative, however, laboratory testing revealed a serum calcium level of 15mg/dL (normal 7.3-10.5mg/dL). We review the published literature regarding the link between hypercalcemia and the appearance of ST elevation.
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Comparative Study
How emergency department (ED) admission decisions differ when the same physician works in two different EDs.
Emergency physicians often work in multiple hospital emergency departments (EDs). We study how emergency physician admission decisions vary in different settings. ⋯ In this sample, some ED physicians made similar admission decisions in different settings while others increased or decreased their admission rates up to 25% when practicing in a different ED.