The American journal of emergency medicine
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Meta Analysis Comparative Study
Balanced crystalloids versus normal saline for fluid resuscitation in critically ill patients: A systematic review and meta-analysis with trial sequential analysis.
Intravenous resuscitation with balanced crystalloid fluids does not reduce mortality or kidney injury compared with normal saline in critically ill patients.
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Clinical Trial
Lung and cardiac ultrasound (LuCUS) protocol in diagnosing acute heart failure in patients with acute dyspnea.
To investigate the accuracy of lung and cardiac ultrasound (LuCUS) protocol in diagnosing Acute Heart Failure (AHF) in patients who refer to Emergency Department (ED) with acute dyspnea. ⋯ LuCUS protocol can be used by EPs as a practical tool to differentiate the cardiac and non-cardiac etiologies of acute dyspnea, specifically AHF, as it is more accurate than clinical diagnosis by itself. Hence, it is recommend that while conducting further studies in order to achieve more generalizable results, EPs can employ it alongside their clinical evaluations to have a faster and more accurate diagnosis.
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Randomized Controlled Trial Comparative Study
Flexible nasotracheal intubation compared to blind nasotracheal intubation in the setting of simulated angioedema.
Nasotracheal intubation is rarely performed in the emergency department (ED) but may be required in specific situations such as angioedema. Both blind and flexible nasal intubation (FNI) may be utilized; however, the preferred technique is unknown. ⋯ FNI and blind nasal intubation require similar time to intubation in this simulated model of angioedema.
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Case Reports
Toluene toxicity presenting with hypokalemia, profound weakness and U waves in the electrocardiogram.
We present the case of a 25-year-old man with progressive limb weakness. His electrocardiogram showed prominent U waves which made us consider hypokalemia. ⋯ The approach to a patient with acute weakness can be challenging. This case reminds us that the electrocardiogram can be a valuable tool in the evaluation and differential diagnosis of patients presenting to the emergency department with these conditions.
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Case Reports
Inflammatory markers limitations in the diagnosis of pediatric calcaneal osteomyelitis.
Calcaneal osteomyelitis is an uncommon, but clinically important emergent condition in the differential of the limping child. Early recognition is paramount to prevent complications from delayed diagnosis like formation of periosteal abscesses or growth plate injury. The diagnosis of pediatric osteoarticular infection relies on a combination of clinical exam, imaging and inflammatory markers. ⋯ Location of infection in small bones like the calcaneus can lead to significantly lower sensitivities than in long bones. Pretreatment with antibiotics prior presentation can also decrease the reliability of ESR and CRP. In this case, we highlight two unique clinical factors that diminish the sensitivity of commonly used inflammatory markers in the diagnosis of pediatric osteomyelitis.