J Emerg Med
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Prothrombin complex concentrate (PCC) is an inactivated concentrate of factors II, IX, and X, with variable amounts of factor VII. Guidelines recommend the use of PCC in the setting of life-threatening bleeds, but little is known on the most effective dosing strategies and how the presenting international normalized ratio affects response to therapy. ⋯ Health care professionals must remain aware of the differences in products and interpret how three- versus four-factor products may affect patients, and interpret literature accordingly. The clinician must be cognizant of how to progress when treating a bleeding patient, propose a supported dosing scheme, and address the need for appropriate factor VII supplementation. At this point, PCC cannot be recommended for first-line therapy in patients with traumatic hemorrhage, and should be reserved for refractory bleeding until more data are available.
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Severe sepsis is a condition with a high mortality rate, and the majority of patients are first seen by Emergency Medical Services (EMS) personnel. ⋯ This pilot study is the first to utilize EMS providers and venous lactate meters to identify patients in severe sepsis. Further research is needed to validate the Sepsis Alert Protocol and the potential associated decrease in mortality.
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Emergency Departments (EDs) are a critical, yet heterogeneous, part of international emergency care. ⋯ Beijing EDs have high volume, long length of stay, and frequent reports of EDs being over capacity. To meet its rapidly growing health needs in urban areas, China should consider improving urban ED capacity and training more Emergency Medicine specialists capable of efficiently staffing its crowded EDs.
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Case Reports
Large-volume hypertonic saline therapy in endurance athlete with exercise-associated hyponatremic encephalopathy.
Small-volume boluses of intravenous hypertonic saline are the recommended therapy for exercise-associated hyponatremic encephalopathy (EAHE). Failure to properly diagnose and treat EAHE has been associated with significant morbidity and death. To prevent this, current consensus statement guidelines recommend up to three 100-mL boluses of 3% NaCl spaced at 10-min intervals to correct symptoms. Due to lack of evidence, however, guidelines are vague regarding the maximal volume that can be safely administered in a given time period beyond these initial boluses. ⋯ Although further research is needed, this case may provide helpful information for acute care and sports medicine physicians who encounter patients with EAHE refractory to initial therapy.
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There is currently limited literature regarding the use of hemodialysis after acute pediatric and adolescent poisoning. ⋯ All salicylate-poisoned patients who underwent HD demonstrated clinical findings indicative of toxicity even in the absence of elevated levels advocated by some as indication for HD. HD and other ECR are rarely used in the management of pediatric and adolescent poisoning.