European journal of emergency medicine : official journal of the European Society for Emergency Medicine
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This study's objective was to ascertain emergency department (ED) patient preferences for pain assessment frequency. This was a prospective, convenience-sample trial of all-diagnosis adults with pain at least 3/10, in an academic ED (census 90 000). Using a computer-based automated pain tracker, patients entered initial pain level and indicated how frequently they wanted pain assessed. ⋯ Regression was used to assess relationships between patient factors and the endpoint 'frequency of preferred pain assessment.' There was no association between initially suggested time interval (median, 15 min) and sex (P = 0.455), race (P = 0.976), age (P = 0.391), or in-room visitors (P = 0.956). Pain severity was associated with preference for more frequent pain assessment (P = 0.009). ED patients' preference for pain assessment is approximately 15 min, with more frequent intervals preferred when pain is severe.
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Page kidney is a rare phenomenon of hyperreninemic hypertension caused by compression of the renal parenchyma. It has been reported in healthy individuals after blunt abdominal or flank trauma, and in patients after invasive nephrological interventions. We present a case of acute on chronic renal failure and Page kidney phenomenon in an elderly male after a traumatic fall, who underwent effective medical management until spontaneous recovery to baseline was observed. A brief discussion on the Page kidney phenomenon is provided with a suggested algorithmic approach towards the management of this process.
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Case Reports
Complete recovery from aneurysmal subarachnoid hemorrhage associated with out-of-hospital cardiopulmonary arrest.
Out-of-hospital cardiopulmonary arrest (OHCPA) because of aneurysmal subarachnoid hemorrhage (SAH) is almost always fatal, because devastating SAH causes OHCPA and the brain damage is aggravated by OHCPA. We report a rare case of a 63-year-old female patient who survived SAH-induced ventricular fibrillation OHCPA without neurologic sequelae. Early brain computed tomography scans were needed for the diagnosis, as most of SAH seemingly disappeared within 7 h after the onset and was associated with acute coronary syndrome-like findings. This case shows that even less severe SAH can cause ventricular fibrillation OHCPA and takotsubo cardiomyopathy, and that early diagnosis and appropriate treatment following immediate, successful resuscitation may lead to a surprisingly favorable outcome.
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Review
Hypokalemic periodic paralysis: a case series, review of the literature and update of management.
The objective of this study was to present a case series of patients with hypokalemic periodic paralysis. We described all patients with diagnosis of hypokalemic periodic paralysis admitted to the Al Ain Hospital (UAE) during the year 2006. Seventeen patients, all males and mostly Asians, were presented to the Al Ain Hospital over a 12-month period. ⋯ In conclusion, clinicians should have a high index of suspicion, especially among Asians presenting with flaccid paralysis and hypokalemia. The main steps in the management include exclusion of other causes of hypokalemia, potassium replacement, hydration and close monitoring of the cardiac rhythm and serum potassium levels. When possible, the underlying cause must be adequately addressed to prevent the persistence or recurrence of paralysis.
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Multicenter Study
Emergencies related to cocaine use: a European multicentre study of expert interviews.
Illicit drug use can lead to acute reverse reactions leading to the admission to emergency departments. Cocaine-related emergencies have been monitored in the USA, but not in Europe so far. The study investigates patterns of cocaine emergencies in eight European cities in a multicentre cross-sectional study conducted in Barcelona, Budapest, Dublin, Hamburg, London, Rome, Vienna and Zurich. ⋯ Patterns of complaints among cocaine users are associated with the psychomotor-stimulant or cardiovascular effects of cocaine. Urine screens and referrals to the addiction services are infrequent. A closer link between the emergency departments and addiction services would help in guiding problematic drug users towards appropriate treatment at an earlier stage in the addiction process.