Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
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Multicenter Study
Can emergency physician gestalt "rule in" or "rule out" acute coronary syndrome: validation in a multi-center prospective diagnostic cohort study.
Chest pain is a common problem presenting to the emergency department (ED). Many decision aids and accelerated diagnostic protocols have been developed to help clinicians differentiate those needing admission from those who can be safely discharged. Some early evidence has suggested that clinician judgment or gestalt alone could be sufficient. ⋯ Clinician gestalt is not sufficiently accurate or safe to either rule in or rule out ACS as a decision-making strategy. This study will enable emergency physicians to understand the limitations of our clinical judgment.
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Randomized Controlled Trial
Patiromer for Treatment of Hyperkalemia in the Emergency Department: A Pilot Study.
Hyperkalemia is common and potentially life threatening. Patiromer is a Food and Drug Administration (FDA)-cleared oral potassium binder effective in the chronic treatment of hyperkalemia. ⋯ In this open-label pilot study of severe hyperkalemia, a single dose of 25.2 g of oral patiromer reduced serum potassium within 2 hours but did not show a difference at 6 hours. This is the first study showing that patiromer may have a role in the acute management of hyperkalemia; however, more rigorous studies are needed.
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Elderly patients presenting to the emergency department (ED) with nonspecific complaints (NSCs) often undergo troponin testing to assess for atypical acute coronary syndrome (ACS). However, the rate of ACS and utility of troponin testing in this population is unknown. We sought to determine the rate of ACS and diagnostic yield of troponin testing in elderly patients with NSCs. ⋯ While consideration for ACS is prudent in selected elderly patients with NSCs, ACS was rare and no patients received reperfusion therapy. Given the false-positive rate in our study, our results may not support routine troponin testing for ACS in this population.
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The Office of the Inspector General has the authority to levy fines relating to violations of the Emergency Medicine Treatment and Labor Act (EMTALA) for both medical and psychiatric care. Terp et al. have described the incidence of violations and penalties levied for psychiatric cases and compared them to that for medical. This article reviews that article and the podcast recorded with Dr. Terp and the ensuing discussion in the podcast and online.