J Emerg Med
-
Review Case Reports
Tetraparesis and Failure of Pacemaker Capture Induced by Severe Hyperkalemia: Case Report and Systematic Review of Available Literature.
In severe hyperkalemia, neurologic symptoms are described more rarely than cardiac manifestations. We report a clinical case; present a systematic review of available literature on secondary hyperkalemic paralysis (SHP); and also discuss pathogenesis, clinical effects, and therapeutic options. ⋯ A 75-year-old woman presented to the emergency department complaining of tetraparesis. Her serum potassium level was 11.4 mEq/L. Electrocardiogram (ECG) showed a pacemaker (PMK)-induced rhythm, with loss of atrial capture and wide QRS complexes. After emergency treatment to restore cell membrane potential threshold and lower serum potassium, neurologic and ECG signs completely disappeared. An acute myocardial infarction subsequently occurred, possibly linked to tachycardia induced by salbutamol therapy. We reviewed 99 articles (119 patients). Mean serum potassium was 8.8 mEq/L. In most cases, ECG showed the presence of tall T waves; loss of PMK atrial capture was documented in 5 patients. In 94 patients, flaccid paralysis was described and in 25, severe muscular weakness; in 65 patients, these findings were associated with other symptoms. Concurrent renal failure was often documented. The most frequent treatments were dialysis and infusion of insulin and glucose. Eighty-seven percent of patients had complete resolution of symptoms. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Severe hyperkalemia is always a life-threatening medical emergency, as it can precipitate fatal dysrhythmias and paralysis. SHP should be considered in the differential diagnosis of neurologic signs and symptoms of uncertain etiology, especially in a subject with kidney failure or who is taking medications that may worsen renal function. The presence of a PMK does not necessarily impede hyperkalemic cardiac toxicity.
-
Randomized Controlled Trial Comparative Study
Paramedic-performed Fascia Iliaca Compartment Block for Femoral Fractures: A Controlled Trial.
Femoral (thigh) fractures are an important clinical problem commonly encountered by paramedics. These injuries are painful, and the need for extrication and transport adds complexity to the management of this condition. Whereas traditional analgesia involves parenteral opioids, regional nerve blockade for femoral fractures have been demonstrated to be effective when performed by physicians. Regional peripheral nerve blockade performed by paramedics may be suitable in the prehospital setting. ⋯ The study suggests that FICB can be performed by trained paramedics for patients with suspected femoral fractures.
-
Review
Statistical Process Control: Separating Signal from Noise in Emergency Department Operations.
Statistical process control (SPC) is a visually appealing and statistically rigorous methodology very suitable to the analysis of emergency department (ED) operations. ⋯ Because data have no meaning apart from their context, and every process generates information that can be used to improve it, we contend that SPC should be seriously considered for driving quality improvement in emergency medicine.
-
Randomized Controlled Trial
Comparative Sonoanatomy of Classic "Short Axis" Probe Position with a Novel "Medial-oblique" Probe Position for Ultrasound-guided Internal Jugular Vein Cannulation: A Crossover Study.
Ultrasound (US)-guided short-axis approach for internal jugular vein (IJV) cannulation does not fully protect patients from inadvertent carotid artery (CA) puncture. Carotid puncture is not rare (occurring in up to 4% of all IJV cannulations) despite the use of US. ⋯ The medial-oblique probe position for IJV cannulation provides sonoanatomic superiority over the classic short-axis probe position. Further randomized, controlled trials may confirm the medial-oblique view's clinical benefit in the future.
-
African tick bite fever (ATBF) is an emerging infection endemic to sub-Saharan Africa and increasingly noted in travelers to the region. ⋯ We present a case of ATBF in a 63-year-old man who presented with complaints of a rash and fever to the emergency department. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Rickettsial diseases are increasingly common and are seen on every continent except Antarctica. Many factors are contributing to their prevalence, and they have become the second most common cause of fever behind malaria in the traveler returning from Africa. Due to the global distribution of rickettsial diseases, as well as increasing international travel, emergency physicians might encounter ill and febrile travelers. A careful travel history and examination will enable the emergency physician to consider spotted fever group rickettsial diseases in their differential diagnosis for single and multiple eschars.