The American journal of emergency medicine
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Comparative Study
Comparison of sustained rate control in atrial fibrillation with rapid ventricular rate: Metoprolol vs. Diltiazem.
The objective of this study was to compare sustained rate control with intravenous (IV) diltiazem vs. IV metoprolol in acute treatment of atrial fibrillation (AF) with rapid ventricular rate (RVR) in the emergency department (ED). ⋯ Choice of rate control agent for acute management of AF with RVR did not significantly influence sustained rate control success. Safety outcomes did not differ between treatment groups.
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Identifying acute kidney injury (AKI) early can inform medical decisions key to mitigation of injury. An AKI risk stratification tool, the renal angina index (RAI), has proven better than creatinine changes alone at predicting AKI in critically ill children. ⋯ This pilot study finds the aRAI to be a sensitive ED-based tool for ruling out the development of in-hospital AKI.
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Spontaneous pneumomediastinum is a rare complication of viral pneumonia. Here we report a case of a 52 year old male who presented with a spontaneous pneumomediastinum in COVID-19 pneumonia, followed by a severe course of disease. We discuss the pathophysiological mechanisms underlying this association as well as its possible clinical implications as a marker of disease severity in COVID-19.
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This case report describes a young patient presenting to the ED with altered mental status several days after being diagnosed with a Boxer's fracture and ultimately discovered to have toxic leukoencephalopathy. We review the clinical features in his presentation leading to his diagnosis, as well as MRI imaging findings frequently found in his condition.