J Emerg Med
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Comparative Study
Respiratory compromise in patients with rattlesnake envenomation.
Respiratory compromise after rattlesnake envenomation (RSE) is an uncommon yet potentially lethal complication. We were interested in determining the frequency of respiratory compromise in patients treated for RSE. The incidence and indications for intubation were also determined. ⋯ Respiratory compromise following RSE is rare, occurring in only 8% of studied patients. Only 2 patients (0.7%) required intubation as a direct consequence of RSE. No one required intubation for antivenin-induced hypersensitivity reactions.
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Case Reports
First place winner. Recurrent febrile seizures: an unusual presentation of nutritional rickets.
Nutritional rickets is a serious disease that is infrequently encountered in the United States today because of the fortification of infant formulas and dairy products with vitamin D. We report a case of undiagnosed nutritional rickets presenting with recurrent febrile seizures. ⋯ The diagnosis was subsequently confirmed by quantitative laboratory testing. We review the historical and cultural factors, symptoms, and physical findings suggestive of this potentially serious yet easily treatable disease.
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Review Comparative Study
Computed tomography diagnosis of facet dislocations: the "hamburger bun" and "reverse hamburger bun" signs.
Unilateral or bilateral facet dislocations are difficult to diagnose. Computed tomography (CT) is being used more extensively to screen patients with suspected cervical vertebral injury. ⋯ Normal facet joints are oriented on a CT examination so that they resemble the sides of a hamburger bun. Facet dislocations upset this relationship and reverse the orientation of the "bun" halves to each other.
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Abnormalities in serum phosphate levels are more prevalent in certain subsets of Emergency Department patients than in the general population. Patients with diabetic ketoacidosis, chronic obstructive pulmonary disease, alcoholism, malignancy, and renal failure are at increased risk. Multiple factors, including nutritional intake, medications, renal or intestinal excretion, and cellular redistribution, are potential etiologies. ⋯ Patients with severe or symptomatic hypophosphatemia should be treated with IV phosphate therapy (0.08-0.16 mg/kg over 6 h) and admitted for monitoring and subsequent serum electrolyte testing. Mild asymptomatic hyperphosphatemia is commonly managed in renal failure by limiting dietary intake and reducing absorption with phosphate-binding salts. Hemodialysis may be required for severe hyperphosphatemia with symptomatic hypocalcemia.