J Emerg Med
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Review
An Evidence-Based Narrative Review of the Emergency Department Management of Acute Hyperkalemia.
The normal range for potassium is within narrow limits. Hyperkalemia is an electrolyte disorder that frequently affects patients in the emergency department (ED), and can result in significant morbidity and mortality if not identified and treated rapidly. ⋯ Hyperkalemia is a frequent electrolyte disorder in the ED. Because of the risk of fatal dysrhythmia due to cardiac membrane instability, hyperkalemia is a medical emergency. There is a lack of scientific evidence on the optimal management of hyperkalemia and more research is needed to establish optimal strategies to manage acute hyperkalemia in the emergency department.
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Telemetry monitoring in patients with low-risk chest pain continues to be highly used despite a 2011 literature review and recommendations by the Clinical Practice Committee (CPC) of the American Academy of Emergency Medicine that did not find quality data to support its use. ⋯ No further quality data were identified to support the use of telemetry monitoring in patients with low-risk chest pains. Telemetry monitoring is unlikely to benefit patients with low-risk chest pain with a low-risk HEART Score.
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Review Case Reports
Transperineal Ultrasound in the Diagnosis of Proctitis in the Emergency Department.
Patients with anorectal complaints commonly present to the emergency department (ED). In patients with prior history of pelvic radiation and those with risk factors for sexually transmitted infections, proctitis is frequently on the differential diagnosis. Computed tomography (CT) scans are frequently done in patients with atypical presentations and those with broader differential diagnoses. Although in cases with suspected uncomplicated proctitis, conducting a point-of-care transperineal ultrasound (TPUS) may provide sufficient data to confirm the diagnosis and ascertain a safe plan for outpatient management, thus limiting the need for CT scan, a frequent flow-limiting step in the ED. ⋯ In this article, we present a brief case series of patients presenting to the ED with anorectal complaints in whom TPUS revealed circumferential symmetric rectal wall edema and pericolonic stranding suggestive of proctitis. History and subsequent imaging further supported these diagnoses; we also briefly detail the patients' clinical course and outcomes. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: We propose the use of TPUS as the screening imaging for anorectal pathologies and those with suspected proctitis to increase its use among emergency physicians. We review the main sonographic features of proctitis alongside reports from clinical cases, as well as the potential advantages of TPUS as a first-line imaging modality as compared with CT or magnetic resonance imaging. Although the complexities of anorectal anatomy can make TPUS a more difficult ultrasound modality to master, integrating TPUS into clinical practice will prove beneficial to both physician and patient.
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In an effort to decrease length of stay (LOS) and reduce overcrowding, many emergency departments (ED) have implemented triage nurse-ordered testing. ⋯ Triage nurses have reasonably similar accuracy as physicians in ordering limb x-ray studies and moderate accuracy for laboratory testing. However, we did not identify a clinically meaningful decrease in ED LOS from the use of nursing triage orders.
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Total hip arthroplasty (THA) is one of the most successful operations in all of medicine in improving patient pain and restoring function. However, complications do arise after primary and revision THA. Dislocation of a THA, also known as instability, occurs in 1-2% of primary THAs and up to 30% of revision THAs. Most dislocations in the United States are initially managed with closed reduction under procedural sedation in emergency departments (EDs) by on-call orthopedists or emergency medicine specialists. ⋯ Dislocation is one of the most common mechanical complications after primary and revision THA. In the majority of the cases, acute closed reduction can be achieved successfully in the ED setting. However, there are specific dislocation types that present unique challenges to acute reduction.