Can J Emerg Med
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To determine whether novices can distinguish between properly and improperly placed guidewires in a vascular access model after only minimal training. ⋯ Sonographic guidewire visualization, a step recommended for ensuring proper vessel cannulation during central venous access, can be accomplished by novices with a high degree of accuracy.
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ABSTRACTHypokalemic periodic paralysis is the most common form of periodic paralysis and is characterized by attacks of muscle paralysis associated with a low serum potassium (K+) level due to an acute intracellular shifting. Thyrotoxic periodic paralysis (TPP), characterized by the triad of muscle paralysis, acute hypokalemia, and hyperthyroidism, is one cause of hypokalemic periodic paralysis. The triggering of an attack of undiagnosed TPP by β2-adrenergic bronchodilators has, to our knowledge, not been reported previously. ⋯ One patient developed hyperkalemia after a total potassium chloride supplementation of 110 mmol. Thyroid function testing was diagnostic of primary hyperthyroidism due to Graves disease in both cases. These cases illustrate that β2-adrenergic bronchodilators should be considered a potential precipitant of TPP.
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ABSTRACTOphthalmologic complaints represent approximately 2% of emergency department (ED) visits. Acute vision loss is the most serious of such presentations and requires prompt assessment for a treatable cause. ⋯ We report the case of a previously healthy 33-year-old man who presented to the ED with acute bilateral vision loss that was ultimately diagnosed as central serous retinopathy (CSR), an idiopathic, self-limited condition that typically affects males age 20 to 50 years. This condition is not mentioned in standard emergency medicine textbooks or the emergency medicine literature, and our hope is that our report will serve to illustrate a typical case of CSR and help prompt emergency physicians to consider this diagnosis in the appropriate circumstances.
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ABSTRACTTrimethoprim/sulfamethoxazole (TMP/SMX), also known as Septra, is a commonly encountered and prescribed antibiotic in emergency department patients. The side effects associated with TMP/SMX are generally mild and self-limited, but serious side effects, including Stevens-Johnson syndrome and drug-induced aseptic meningitis, have been reported. We discuss the case of a 33-year-old woman who presented to our emergency department with the signs and symptoms of meningeal inflammation after being prescribed TMP/SMX 3 days earlier for an abscess with cellulitis.
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ABSTRACTObjectives:This study assessed the use and clinical yield of diagnostic imaging (radiography, computed tomography, and medical resonance imaging) ordered to assist in the diagnosis of acute neck injuries presenting to emergency departments (EDs) in Kingston, Ontario, from 2002-2003 to 2009-2010. Methods:Acute neck injury cases were identified using records from the Kingston sites of the Canadian National Ambulatory Care Reporting System. Use of radiography was analyzed over time and related to proportions of cases diagnosed with clinically significant cervical spine injuries. ⋯ Increased clinical yield was not observed in association with higher neck imaging rates whether that yield was expressed as a percentage of total cases positive for clinically significant injury (p = 0.29) or as a percentage of neck-imaged cases that were positive (p = 0.77). Conclusions:We observed increases in the use of diagnostic images over time, reflecting a need to reinforce an existing clinical decision rule for cervical spine radiography. Temporal increases in the clinical yield for total cases may suggest a changing case mix or more judicious use of advanced types of diagnostic imaging.