J Emerg Med
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Rhabdomyolysis is an uncommon complication of hyponatremia, reported previously only in case reports and small retrospective studies, and its underlying mechanism is controversial. Some studies support the hypothesis that the rapid correction of hyponatremia is responsible for rhabdomyolysis, whereas others emphasize the severity of the hyponatremia as a predisposing factor for rhabdomyolysis. ⋯ The present study, which is the first to test the association between hyponatremia and rhabdomyolysis in an animal model, does not support any causal association between hyponatremia and rhabdomyolysis. Thus, other factors might be necessary for an association between hyponatremia and rhabdomyolysis, such as genetic factors or convulsions that are known to be associated with both hyponatremia and rhabdomyolysis. Further research in this important physiologic and clinical question is needed.
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Pregnancy after hysterectomy is an extremely rare event. However, if not diagnosed and managed properly, it may result in life-threatening consequences. ⋯ The possibility of pregnancy should be considered in the differential diagnosis of abdominal pain in women with intact ovaries despite a history of hysterectomy. A pregnancy test should be a part of the diagnostic work-up of these patients when they present in the emergency department.
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Resuscitation of any critically ill patient is aimed at restoration of oxygen delivery to maintain aerobic metabolism. Thus, "endpoints" of resuscitation have been sought after as a measure of evaluating the adequacy of resuscitation. This review article describes the most commonly used endpoints, central venous oxygen saturation (ScvO2) and lactate, and provides a clinically useful paradigm for utilizing these endpoints during resuscitation of critically ill patients in the emergency department (ED). ⋯ ScvO2 and lactate are useful endpoints of resuscitation, and when used together, provide a metabolic framework for guiding targeted therapy for critically ill patients in the ED with shock.
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Case Reports
Descending Necrotizing Mediastinitis With Diffuse ST Elevation Mimicking Pericarditis: a Case Report.
Descending necrotizing mediastinitis (DNM) is a potentially fatal disease that requires aggressive treatment, including mediastinal exploration. The inflammation associated with DNM may involve the heart, which produces acute changes in the electrocardiogram (ECG). As a result, the ECG may mimic pericarditis, causing some diagnostic confusion. ⋯ The present case highlights the importance of considering a mediastinal cause for acute ECG changes.