The American journal of emergency medicine
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Current protocols which include the administration of a single dextrose dose concomitantly with insulin are inadequate as hypoglycemia commonly occurs 60 min after insulin administration and may persist for up to two hours post-insulin administration. To prevent delayed hypoglycemic events, our institution revised our adult acute hyperkalemia order set to include hypoglycemic preventative measures not currently described in the literature. ⋯ Our study found that our approach of additionally administering a 250 mL dextrose 10% solution upon therapy initiation is associated with significantly lower rates of hypoglycemia. Our findings indicate that hypoglycemia rates can be significantly reduced in vulnerable populations if additional preventative measures are employed.
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To determine frequency that ED visits are needed, and the most common chief complaints and medications prescribed to Veterans with spinal cord injuries and disorders (SCI/D). ⋯ This national study of Veterans with SCI/D characterized ED healthcare utilization. Overall, more than half of Veterans with SCI/D required an ED visit during the five-year study period and over one third of Veterans in each fiscal year required an ED visit. Interventions to target prevention of ED visits and subsequent hospitalizations could focus on these areas.
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A nomogram is a visualized clinical prediction models, which offer a scientific basis for clinical decision-making. There is a lack of reports on its use in predicting the risk of arrhythmias in trauma patients. This study aims to develop and validate a straightforward nomogram for predicting the risk of arrhythmias in trauma patients. ⋯ The nomogram developed in this study is a valuable tool for accurately predicting the risk of post-traumatic arrhythmias, offering a novel approach for physicians to tailor risk assessments to individual patients.
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Observational Study
Optimizing outcomes: A retrospective analysis of discharge safety for elderly mTBI patients on anticoagulation therapy.
Mild traumatic brain injuries (mTBIs) pose a significant risk, particularly in the elderly population on anticoagulation therapy. The safety of discharging these patients from the emergency department (ED) with a negative initial computed tomography (CT) scan has been debated due to the risk of delayed intracranial hemorrhage (d-ICH). ⋯ In elderly patients on anticoagulation with mTBI and a negative initial CT, admission was associated with a higher risk of d-ICH compared to discharge. These findings have implications for clinical decision-making in this high-risk population.
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Observational Study
The prevalence of complicated cervical injuries in near-hanging patients without abnormal levels of consciousness or neck signs.
Cervical injuries are important complications of near-hanging, which is defined as self-injury by hanging if the patient survives at admission. Previous studies have reported that complicated cervical injuries due to near-hanging are uncommon. The primary aim of this study was to evaluate whether cervical imaging can be safely omitted for near-hanging patients who are alert and have no abnormal neck symptoms or signs. ⋯ There were no cases of complicated cervical injuries among near-hanging patients with normal levels of consciousness and no abnormal neck symptoms or signs. Further prospective multicenter studies are warranted to investigate whether cervical imaging can be safely omitted in assessments of these patients.