The American journal of emergency medicine
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Gross hematuria is a very common complaint in emergency departments and outpatient clinics. Globally, the incidence of hematuria is 4 per 1000 patients per year. ⋯ However, hematuria rarely causes hypovolemic shock or an emergent, life-threatening condition at the initial presentation. In this report, we describe the case of a 64-year-old man who suffered a life-threatening gross hematuria in a very short time due to ruptured renal arteriovenous malformations (AVMs).
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The incidence of urinary tract infection (UTI) due to extended-spectrum β-lactamase (ESBL)-producing Escherichia coli has increased over recent years. Initial empirical therapy is often ineffective for these resistant isolates resulting in prolonged hospitalization and increased mortality. This study was conducted to determine the risk factors of UTI caused by ESBL E. coli in the emergency department (ED). ⋯ The main risk factors identified in our study should be considered when treating UTI patients in ED. Amikacin may improve the outcome of empirical treatment without increasing carbapenem utilization.
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Observational Study
Poor outcomes of out-of-hospital cardiac arrest at dinnertime in the elderly: Diurnal and seasonal variations.
To investigate differences in chronological variations in characteristics and outcomes of out-of-hospital cardiac arrests (OHCAs) between elderly and non-elderly patients. ⋯ Dinnertime, particularly in winter, is associated with lower survival in elderly OHCA patients.
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Case Reports
Hemodialysis in metformin-associated lactic acidosis due to acute overdose in a metformin-naïve patient.
Metformin is a common and generally well-tolerated medication in the treatment of diabetes but rarely has been implicated as the cause for metformin-associated lactate acidosis. This is usually caused by decreased elimination from renal dysfunction but is rarely described after an acute ingestion. We present a case of an acute intentional overdose of metformin in a metformin-naïve patient without renal dysfunction. ⋯ Despite attempts at alkalinization, the patient developed a lactic acidosis with a pH of 6.9 and lactate of 33 mmol/L. Hemodialysis was performed with rapid improvement of clinical status. This case provides a clinical context in the acute setting and illustrates the rare need for extracorporeal support in this setting, which may be lifesaving.
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The objective of this study was to describe recent trends in the epidemiology of lawn mower injuries presenting to the Emergency Department in the United States using nationally representative data for all ages. ⋯ Lawn mowers continue to account for a large number of injuries every year in the United States. The incidence of lawn mower injuries showed no decrease during the period of 2005-2015. Preventative measures should take into account the epidemiology of these injuries.