The American journal of emergency medicine
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To determine the significance of routine serum magnesium determination in the ED, a retrospective analysis was done on 253 patients in whom serum magnesium levels were examined in the department of EM. Mild, moderate, and severe hypomagnesemia was found in 19.5%, 9.1%, and 2.5% of the study population, respectively. ⋯ The number of patients admitted to the hospital and the number of patients who died was not statistically significantly different between the groups of patients with normal serum magnesium levels as compared with those with low serum magnesium levels. Although hypomagnesemia was found in 31% of the study population, its clinical significance is not clear given the absence of hypomagnesemia-related complications and death.
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Children who have had surgical correction for congenital heart disease can present to the ED with an acute illness that could be associated with their cardiac lesion. There is no data available to summarize complications that could be associated with surgically corrected congenital heart disease. This work was undertaken to describe the common procedures used, list known complications of these procedures, and review general management principles in caring for the acutely ill child who has had heart surgery.
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Comparative Study
Troponin T in elders with suspected acute coronary syndromes.
Troponin T (TnT) elevations (> or =0.1 ng/mL) indicate an increased risk of adverse outcomes in patients with acute coronary syndromes (ACS). There is little data on the prognostic significance of TnT in elders with ACS. We sought to define the ability of TnT to predict adverse outcomes in elders with suspected ACS compared with the younger cohort. ⋯ Although there was no difference in TnT sensitivity between the younger and older cohorts, there was a difference in specificity, 94% versus 83% (P <.01), respectively. In both cohorts, renal insufficiency was associated with a significantly lower TnT specificity. In both elders and younger patients with abnormal renal function, low TnT specificity warrants careful consideration of this marker as the sole criterion for aggressive medical management.
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Randomized Controlled Trial Clinical Trial
The effect of ED prescription dispensing on patient compliance.
The objective of this study was to evaluate whether dispensing prescriptions in the ED affects patient compliance and return visits to the hospital. Seventy-four patients who were deemed suitable candidates for outpatient therapy with a macrolide antibiotic were identified and prospectively randomized to receive either an entire course of azithromycin from the ED or a prescription for azithromycin to be filled at a local pharmacy free of charge. Pharmacy records and telephone interview were used to measure compliance with patients. ⋯ We conclude that delivery of prescriptions in the ED significantly increases the likelihood that the patient will obtain the medication prescribed. Whether the patients actually take the medication as directed is unknown. Patient's self-report did not accurately reflect true compliance and more objective means for measuring compliance is warranted.