The American journal of emergency medicine
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Case Reports
Transient vocal cord paralysis following central venous hemodialysis catheter insertion.
In this article, we present a case of recurrent laryngeal nerve palsy not caused by nerve injury but due to local anesthetic infiltration that was applied prior to central venous catheterization. A 47-year-old female patient was admitted to emergency room with fatigue and nausea and was diagnosed with acute renal failure. Right jugular venous catheterization was performed for emergency hemodialysis with Seldinger technique using middle approach. ⋯ We think temporary vocal cord palsy in our case was due to local anesthetic infiltration rather than nerve injury, since it resolved spontaneously within only hours. Expectant treatment is a good choice ensuring the patient's airway is safe. Emergency physicians should be aware of this rare complication and its right management.
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Comparative Study
Comparison of qSOFA score and SIRS criteria as screening mechanisms for emergency department sepsis.
The Quick Sequential [Sepsis-related] Organ Failure Assessment (qSOFA) score has been shown to accurately predict mortality in septic patients and is part of recently proposed diagnostic criteria for sepsis. We sought to ascertain the sensitive of the score in diagnosing sepsis, as well as the diagnostic timeliness of the score when compared to traditional systemic inflammatory response syndrome (SIRS) criteria in a population of emergency department (ED) patients treated in the ED, admitted, and subsequently discharged with a diagnosis of sepsis. ⋯ Although qSOFA may be valuable in predicting sepsis-related mortality, it performed poorly as a screening tool for identifying sepsis in the ED. As the time to meet qSOFA criteria was significantly longer than for SIRS, relying on qSOFA alone may delay initiation of evidence-based interventions known to improve sepsis-related outcomes.
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Comparative Study Observational Study
Serum sodium correction rate and the outcome in severe hyponatremia.
We investigated the serum sodium correction rate on length of hospitalization and survival rate, in severe chronic hyponatremic patients at the Emergency Department (ED). ⋯ We observed that serum sodium correction rate ≥0.3 and <0.5mmol/h was associated with a shorter length of hospital stay and a major survival rate.
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Fever is one of the most common complaints in the emergency department (ED) and is more complex than generally appreciated. The broad differential diagnosis of fever includes numerous infectious and non-infectious etiologies. An essential skill in emergency medicine is recognizing the pitfalls in fever evaluation. ⋯ Any fever evaluation must rigorously maintain a broad differential to avoid pitfalls that can have patient care consequences. Fever is complex and due to a variety of etiologies. An understanding of the pathophysiology, causes, and assessment is important for emergency physicians.