The American journal of emergency medicine
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The care of children is an integral aspect of emergency medicine. This article reviews the many important contributions that emergency physicians have made in advancing the acute care of children.
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To determine the change in number of endotracheal intubations per paramedic after the implementation of Combitube use and to explore consequences. ⋯ After implementation of the Combitube, the number of endotracheal intubation attempts/paramedic and success rates decreased.
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To determine the minimum clinically significant difference (MCSD) in patient-assigned, 11-point numeric rating scale (NRS-11) scores for pain and to determine if the MCSD varied with demographic characteristics. ⋯ Findings suggest that a change of 1.39 +/- 1.05 (95% confidence interval, 1.27-1.51) on the NRS-11 is clinically significant when measuring pain.
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Controlled Clinical Trial
Correction of factitious hyperkalemia in hemolyzed specimens.
Hemolysis in pediatric specimens is common due to difficult blood draws and small-bore intravenous catheters. Values of serum K+ become falsely elevated secondary to release of intracellular contents. If a reliable correction factor existed for this factitious elevation, repeat K+ measurements might be avoided. ⋯ A reliable correction factor for factitious hyperkalemia in a clinically relevant range exists. By example, using the above correction factor, one can predict that the delta K+ in a specimen with 500 mg/dL of p-Hgb will be 1.6 mEq/L (range, 1.5-1.7). We suggest that when the lower bound of the predicted delta K+ results in a corrected value within the reference range, a second blood draw is unnecessary.
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Cardiac troponin I (cTnI) is considered the most specific marker of cardiac muscle injury. We encountered several patients with rhabdomyolysis and elevated cTnI, although they did not otherwise have evidence of cardiac injury. We determined the prevalence of false-positive cTnI in emergency department (ED) patients with rhabdomyolysis. ⋯ The prevalence of false-positive cTnI in ED patients with rhabdomyolysis is 17%.