The American journal of emergency medicine
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We present a case of 2-dimensional ultrasound-assisted confirmation of nasogastric tube (NGT) placement using both soft tissue neck and epigastric sonographic imaging. Given our findings and review of the literature, we suggest that bedside ultrasound evaluation of NGT placement is a straightforward, rapid, and novel alternative method to the “gold standard” of a portable chest radiograph in the emergency department (ED).
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Use of online formulas to treat hyponatremia is a common practice. We report here that while using the same goal of correction and type of infusate to treat a patient with hyponatremia, a large discrepancy in infusion rate is obtained from using the 2 commonly available online equations. ⋯ When the therapy fluid is hypertonic saline (3%), these formulas may result in overly rapid correction. We should, thus, never use these formulas blindly in the management of patients with hyponatremia.
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Case Reports
Severe hypercalcemia in nonobstructive pyelonephritis with acute renal failure: hit or miss?
Severe hypercalcemia in the course of renal failure is quite unusual. If unrecognized, irreversible inexorable attrition of renal function takes place, carrying a substantial morbidity and mortality. ⋯ We report a case with severe hypercalcemia after acute renal failure caused by fulminating bacterial pyelonephritis. To obviate unnecessary intervention, preserve organ function, and achieve better outcomes, clinicians should not miss this entity.
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The aim of the present study was to assess whether the combination of epinephrine, vasopressin, and nitroglycerin would improve initial resuscitation success, 24-hour survival, and neurologic outcome compared with epinephrine alone in a swine model of asphyxial cardiac arrest (CA). ⋯ In this porcine model of asphyxial CA, the addition of nitroglycerin to vasopressin and epinephrine maintained elevated coronary perfusion pressure during asphyxia CA and resulted in significantly better neurologic and histopathologic outcome in comparison with epinephrine alone.