J Emerg Med
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Few data exist on the frequency with which multidetector computed axial tomography (MDCT) scan of the coronary arteries changes the admission decisions of emergency physicians (EP) caring for patients with possible acute coronary syndrome (ACS). We measured if and how often these changes in decision-making would occur. ⋯ An MDCT scan of the coronary arteries will likely change emergency physicians' decisions on the disposition of patients presenting with possible ACS, many to appropriate discharges but also a minority to inappropriate admissions.
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Increasing numbers of operators are learning to use ultrasound to guide peripheral intravenous (i.v.) catheter insertion in patients with difficult access. Unfortunately, failed cutaneous punctures are common. Some veins seen on ultrasound may be better choices than others. ⋯ Success rates are higher in larger veins (> or = 0.4 cm) and veins at moderate depth (0.3-1.5 cm).
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Metformin, widely used in the treatment of diabetes mellitus, is known to cause lactic acidosis in both therapeutic use and after an overdose. We report the case of a 40-year-old woman who claimed to have ingested between 75 and 100 grams of metformin and subsequently developed severe lactic acidosis. She eventually developed a peak serum lactate level of 40.0 mmol/L and a serum pH nadir of 6.59 and became obtunded, hypotensive, and hypothermic. ⋯ The overall management of metformin overdose is reviewed. This case represents the largest reported amount of ingested metformin, the lowest serum pH, and the highest serum lactate concentration in any intentional metformin overdose survivor in the literature. Despite potentially lethal metabolic derangements, such patients can survive with aggressive supportive care.
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Burns are a common cause of injury presenting to the Emergency Department (ED). Several reports state that admission for and mortality from burn injury are declining. Total visits to the ED, however, have increased. ⋯ ED visits for burn injuries have been decreasing; however, patterns of cause, admission, and treatment show no consistent temporal change.
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Case Reports
Superior cluneal nerve block for treatment of buttock abscesses in the emergency department.
The buttock is a common location for cutaneous abscesses among patients presenting for emergency department care. Procedural pain management sufficient to permit adequate incision and drainage often requires moderate sedation or general anesthesia. ⋯ Our experience suggests that superior cluneal nerve blockade may reduce the need for procedural sedation, expedite care, and reduce costs for some patients presenting with buttock abscesses.