J Emerg Med
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Clinical Trial
Successful Discharge of Children with Gastroenteritis Requiring Intravenous Rehydration.
Emergency Department (ED) revisits are very common in children with gastroenteritis administered intravenous rehydration. ⋯ Lower serum bicarbonate values at the time of intravenous rehydration are not associated with unfavorable outcomes after discharge.
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Case Reports
Elevated Compartment Pressures from Copperhead Envenomation Successfully Treated with Antivenin.
Copperhead envenomation causes local soft tissue effects; however, associated compartment syndrome is rare. We report a case of a 17-month-old with significantly elevated compartment pressures successfully treated with antivenin and supportive care. ⋯ In this case, early and aggressive treatment with antivenin may have avoided invasive fasciotomy, and its use should be considered in patients with copperhead envenomation and significantly elevated compartment pressures.
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Cardiac syncope is associated with poor outcomes and may result in traumatic injuries. In patients presenting to the emergency department (ED) with trauma, recognizing the cause of syncope is particularly challenging. Also, clinical markers to identify cardiac syncope are not well established. ⋯ In patients with traumatic falls and syncope, simple clinical and electrocardiographical variables may identify patients with cardiac causes of syncope. Proper identification of cardiac syncope in this population can potentially prevent recurrence of life-threatening traumatic injury.
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The yield of urine culture testing in the emergency department (ED) is often low, resulting in wasted laboratory and ED resources. Use of a reflex culture cancellation protocol, in which urine cultures are canceled when automated urinalysis results predict that culture yield will be low, may help to conserve these resources. ⋯ These results suggest that a substantial reduction in urine culture testing might be achievable by implementing this protocol. Confirmation of these findings in a validation cohort is necessary.
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Chest pain accounts for a significant number of visits to the Emergency Department. Lung herniation is an uncommon cause of chest pain, but one that is easily treated. Patients may complain of pain or present with ecchymosis or a visible bulge in the chest wall. Most lung herniations are located anteriorly or at the thoracic inlet, due to the lack of musculature in these areas. We present a unique case of a right lateral lung herniation and subsequent development of a spontaneous right-sided transdiaphragmatic hernia. ⋯ To our knowledge, this is the first reported case of a patient presenting with spontaneous right-sided lateral lung herniation and spontaneous right-sided transdiaphragmatic hernia. This case is unusual given the location of the hernias, and is unique in the spontaneous development of the hernias without any inciting history of trauma.