J Emerg Med
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Orbitocranial complications (OCCs) of sinusitis are uncommon but potentially life threatening. OCCs carry high morbidity, mortality, and significant long-term sequelae. Late recognition leads to even worse outcomes. ⋯ The difficult complications of acute sinusitis in the pediatric age group should be anticipated, recognized early, and aggressively managed to prevent morbidity and a fatal outcome.
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Current guidelines recommend avoiding atrioventricular-nodal blocking agents (AVNB) when treating tachydysrhythmias in Wolff-Parkinson-White syndrome (WPW) patients. ⋯ In this sample of WPW-associated tachydysrhythmia patients, many were treated with AVNBs. The composite outcome was similarly met after use of either AVNB or NAVNB, and no malignant dysrhythmias were observed.
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Evidence for a standard x-ray study and cast immobilization in emergency department (ED) management and follow-up of children with bicycle spoke injury (BSI) is absent. ⋯ A quarter of ED patients with BSI have a fracture with no clinical signs that could predict the presence of a fracture, justifying a standard x-ray study in ED management. Only 12% of ED patients with BSI have no fracture and no signs that predict long-term follow-up. In this group, further studies are warranted to investigate the benefit of cast immobilization for fractures and soft tissue injury.
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To many physicians, hyperkalemia is the first diagnosis ascribed to any patient with end-stage renal disease and abnormal electrocardiographic morphologies or dysrhythmias. ⋯ An emergency physician's differential diagnosis of sudden cardiac arrest in the patient with end-stage renal disease should not be limited to hyperkalemia and myocardial infarction. Hypokalemia should also be considered. Hypokalemia may be an under-recognized cause of sudden cardiac death in this patient population.