Articles: emergency-department.
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Pediatric emergency care · Jan 2014
Case ReportsThyrotoxic periodic paralysis in a pediatric patient.
Thyrotoxic periodic paralysis is a reversible metabolic disorder that is characterized by acute muscle weakness and hypokalemia. It predominantly affects males of Asian descent. ⋯ Laboratory test results initially revealed marked hypokalemia and later confirmed associated hyperthyroidism. Correction of the hypokalemia reversed the patient's weakness in the emergency department.
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Observational Study
The caval index: an adequate non-invasive ultrasound parameter to predict fluid responsiveness in the emergency department?
Fluid therapy is the first important step in patients with signs of shock but assessment of the volume status is difficult and invasive measurements are not readily available in the emergency department. We have investigated whether the respiratory variation in diameter of the inferior vena cava is a reliable parameter to predict fluid responsiveness in spontaneous breathing emergency department patients with signs of shock. ⋯ In spontaneously breathing patients with signs of shock in the emergency department, a high caval index (>36.5%) does not reliably predict fluid responsiveness in our study, while a low caval index (<36.5%) makes fluid responsiveness unlikely. An explanation for the absence of a blood pressure response in the group of patients with a low high caval index might be that these patients represent a group requiring more volume therapy than 500 ml.
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Pediatric emergency care · Jan 2014
Multicenter StudyInterhospital Pediatric Patient Transfers-Factors Influencing Rapid Disposition After Transfer.
The objective of this study was to determine the incidence, demographics, and clinical course of pediatric patients rapidly discharged after transfer from outlying emergency departments (EDs) to a tertiary care pediatric ED (PED) with no additional diagnostic or therapeutic actions. ⋯ Pediatric patients transferred from outlying community EDs to a PED frequently required little or no additional care. Referring hospital ED type and physician training type are associated with the need for additional workup at the pediatric emergency room.
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Clinical biochemistry · Jan 2014
Elevated serum ubiquitin C-terminal hydrolase-L1 levels in patients with carbon monoxide poisoning.
Ubiquitin C-terminal hydrolase-L1 (UCH-L1) has been established as a reliable and potential biomarker of neuronal damage after acute neurologic insults, such as ischemic stroke, subarachnoid hemorrhage, and traumatic brain injury. However, the effect of serum UCH-L1 levels has not been investigated in carbon monoxide (CO)-poisoned patients. The aim of the present study was to evaluate whether serum UCH-L1 levels are a reliable marker of brain damage and the association of UCH-L1 with outcome. ⋯ Serum levels of UCH-L1 appear to have potential clinical utility in providing valuable information about poisoning severity and outcome after CO poisoning.
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Reperfusion of ST elevation myocardial infarction (STEMI) is most effective when performed early. Notification of the cardiac catheterization laboratory (cath lab) prior to hospital arrival based on paramedic-performed ECGs has been proposed as a strategy to decrease time to reperfusion and mortality. The purpose of this study was to compare the effects of cath lab activation prior to patient arrival versus activation after arrival at the emergency department (ED). ⋯ Prehospital cath lab activation based on the prehospital ECG was associated with decreased door-to-balloon times but did not affect hospital mortality. False-positive activation was common and occurred more often with prehospital STEMI diagnosis.