American family physician
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Wide complex tachycardias are cardiac rhythm disorders with three or more consecutive beats, rates exceeding 100 beats per minute and a QRS duration of 120 msec (0.12 second) or greater. The width of the QRS complex should be verified in a number of leads, since the QRS complex often appears mistakenly narrower (i.e., a QRS duration of less than 120 msec) in one or two of the 12 leads. Most wide complex tachycardias are ventricular tachycardia, and they are managed with antiarrhythmic drugs and correction of serum potassium and magnesium levels. ⋯ The cause of a wide complex tachycardia must be identified, because certain therapies can result in potentially fatal arrhythmias. If the cause cannot be determined, a test dose of intravenous adenosine can be used. Another approach is intravenous administration of procainamide and a beta-adrenergic blocker.
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Transient synovitis is the most common cause of acute hip pain in children three to 10 years of age. Children with this condition typically present with hip pain for one to three days, accompanied by limping or the refusal to bear weight. Transient synovitis has an uncertain etiology and remains a diagnosis of exclusion. ⋯ Hip aspiration is the diagnostic procedure of choice if septic arthritis is suspected. Treatment of transient synovitis consists of bed rest and nonsteroidal anti-inflammatory drugs, with regular temperature checks to exclude the onset of fever. If significant pain and limping persist seven to 10 days after the initial presentation, the patient should be reevaluated.