The American journal of emergency medicine
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As physicians attempt to "Choose Wisely" and decrease ionizing radiation, the use of Magnetic Resonance Imaging (MRI) has increased. While MRI does not expose patients to ionizing radiation, it does expose patients to specific risks, such as thermal burns. Unfortunately, obese patients are at the highest risk for MRI-related thermal burns. ⋯ The burn required debridement twice at the nearest burn center and healed slowly thereafter. Emergency physicians should be aware of the risks of MRI so they can counsel patients prior to diagnostic MRI and adequately evaluate patients with complaints after MRI. Furthermore, patients with MRI-related burns may rarely present with delayed, occult deep-tissue involvement requiring burn center evaluation and treatment.
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Acute heart rate control for atrial fibrillation (AF) with rapid ventricular response (RVR) in the emergency department (ED) is often achieved utilizing intravenous (IV) non-dihydropyridine calcium channel blockers (CCB) or beta blockers (BB). For patients with concomitant heart failure with a reduced ejection fraction (HFrEF), the American Heart Association and other clinical groups note that CCB should be avoided due to their potential negative inotropic effects. However, minimal evidence exists to guide this current recommendation. The primary objective of this study was to compare the incidence of adverse effects in the HFrEF patient population whose AF with RVR was treated with IV diltiazem or metoprolol in the ED. ⋯ In HFrEF patients with AF, there was no difference in total adverse events in patients treated with IV diltiazem compared to metoprolol. However, the diltiazem group had a higher incidence of worsening CHF symptoms defined as increased oxygen requirement within four hours or initiation of inotropic support within 48 h.