The American journal of emergency medicine
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Potassium chloride and other potassium compounds are used by the general public as salt substitutes, muscle-building supplements, and panacea. Severe hyperkalemia from oral potassium is extremely rare if kidney function is normal because of potassium adaptation. The oral potassium dose has to be large enough to overcome the normal renal excretory mechanisms to cause severe hyperkalemia. ⋯ Once an urgent situation has been handled with intravenous push of a 10% calcium salt, short-term measures should be started with agents that cause a transcellular shift of potassium, namely, insulin with glucose, β2-agonist, and NaHCO(3). Patients are unaware of these potentially serious adverse effects, and there are inadequate consumer warnings. Clinicians should be vigilant in monitoring potassium intake from over-the-counter supplements.
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The objective of the study was to describe the utility of emergency department (ED)/outpatient management after enema reduction for childhood intussusception. ⋯ Outpatient management is used for the majority of patients with intussusception at our institution after enema reduction. The early recurrence rate is low, and patients with recurrence after discharge do well without adverse outcomes. Emergency department observation of patients after enema reduction appears to be safe and should be routine for uncomplicated cases of intussusception.
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The aims of the study were to prospectively evaluate the Alvarado and Samuel (pediatric appendicitis score [PAS]) appendicitis scoring systems in children and determine performance based on sex. ⋯ Regardless of sex, neither PAS nor Alvarado has adequate predictive values for sole use to diagnose appendicitis.
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Comparative Study
Etomidate for procedural sedation in the elderly: a retrospective comparison between age groups.
The objective of the study was to compare the complication rate and length of stay (LOS) between the elderly (65 years and older) and the adult (18-64 years old) populations when etomidate is used for procedural sedation in the emergency department (ED). ⋯ Etomidate remains as safe and effective an alternative for procedural sedation in the elderly as it is in the general aged population.
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Hyperthyroidism is a relative uncommon but important cause of atrial fibrillation. The aim of this study was to investigate the utility of routine thyroid-stimulating hormone (TSH) determination in the emergency department (ED) in patients presenting to the ED with stable, new-onset atrial fibrillation. We derive a set of clinical criteria in which TSH is likely to be normal and therefore thyroid function evaluation deferrable to a different time from ED visit. ⋯ Hyperthyroidism is present in nearly 10% of new-onset atrial fibrillation. Although thyroid function screening is recommended in all patients, a simple model that included previous thyroid disease, stroke, and hypertension might help to identify those patients at high risk (low TSH) in the ED.