European journal of emergency medicine : official journal of the European Society for Emergency Medicine
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Field trauma triage systems currently used by emergency responders at mass casualty incidents and disasters do not adequately account for the possibility of contamination of patients with chemical, biological, radiological, or nuclear material. Following a discussion of background issues regarding mass casualty triage schemes, this paper proposes chemical, biological, radiological, or nuclear-compatible trauma triage algorithms, based on a review of the literature and the input of recognized content experts. ⋯ This template is then modified for use in chemical, biological, and radiation/nuclear situations in which the exposed or contaminated victims have also sustained conventional trauma. The proposed algorithms will need further refinement and testing.
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We present and discuss the case of a man admitted to our emergency room because of severe hypercalcemia and renal failure with maintained diuresis. We diagnosed a relapse of sarcoidosis, manifesting as hypercalcemia and renal failure, based on a history of lung sarcoidosis. This is a rare complication of sarcoidosis, due to granulomatous production of vitamin D. ⋯ The initial treatment of the patient was directed towards lowering the circulating calcium level through hyperhydration and forced diuresis, with secondary control of granulomatous activity using corticosteroid therapy. The patient was discharged after 7 days with normal levels of serum calcium, urinary calcium excretion and serum creatinine. Recognition of this rare cause of hypercalcemia is a challenge for the emergency physician.
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We describe three patients with myasthenia gravis who presented to the emergency department - one with a previously established diagnosis and two others who were newly diagnosed as a result of workup initiated in the emergency department. Differential diagnosis of conditions causing neuromuscular weakness is broad; however, a key aspect of myasthenia gravis is fluctuating muscle weakness that increases with repeated use and improves with rest. ⋯ The third patient presented with a potentially life-threatening myasthenic crisis. Key points of discussion include: bedside tests to diagnose myasthenia gravis; distinction between cholinergic versus myasthenic crisis; and emergency department considerations when intubating a myasthenia gravis patient becomes necessary.
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Peritonism is a finding that leads to a more cautious approach in the emergency department management of abdominal pain. This study examined whether peritonism assessment using inspiration, expiration and cough tests was associated with the patient's clinical management. ⋯ These peritonism tests represent a simple investigation, and are significantly associated with admission when all three tests are positive. They seem to be a clinical predictor of cases in which continuing assessment was required, and may be useful as a departmental 'safety net' in the management of abdominal pain.
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In a patient with diabetes mellitus undergoing icodextrin continuous ambulatory peritoneal dialysis, the interference caused by icodextrin metabolites in bedside glucose analyzers led to an overestimation of capillary glucose levels and the potential for inappropriate therapy. We report this case to raise an awareness of this among emergency care providers who are at the front-line treating diabetes emergencies.