J Emerg Med
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Obtaining vascular access is difficult in certain patients. When routine peripheral venous catheterization is not possible, several alternatives may be considered, each with its own strengths and limitations. ⋯ Although further study of this technique is required, we believe this procedure may be a valuable option for ED patients requiring rapid vascular access.
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Standard practice has been to admit children for an observation period after enema-reduced intussusception. However, the utility of such routine practice has not been clearly justified. ⋯ Given the low early recurrence rate for enema-reduced intussusception and the minimal risk of adverse outcomes, ED observation for a 6-h period seems to be a safe alternative to inpatient management. These results support previous work and suggest that these patients can be managed on an outpatient basis.
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Foreign body (FB) ingestions are frequent in children. Whereas the majority of FBs pass spontaneously through the gastrointestinal tract, ingestion of magnetic FBs pose a particular risk for obstruction due to proximate attraction through the intestinal wall. ⋯ Although ingestion of a single magnetic FB may, in most cases, be managed as a simple FB ingestion, the ingestion of multiple magnetic FB is associated with a high risk of complication and requires aggressive management. We propose an algorithm for management of children with magnetic FB ingestions.
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The debate on the quality of health care provided in the United States has continued to be waged as concerns have grown over the years. Stress, sleep deprivation, poor diet, and lack of exercise may lead to inadequate work performance by physicians. ⋯ A majority of residents (90%) did not meet the target number of steps for shifts. More rigorous charting needs, overcrowding, or even spatial limitations may explain this. This warrants further investigation to determine if some daily physical activity regimens may help improve the overall well-being of EM residents.
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Reintroduction of nutrition to the chronically starved patient presents a constellation of metabolic challenges termed "refeeding syndrome." The consequences of this syndrome--principally hypophosphatemia--may be life threatening. Although previously described in the nutritional literature, little information exists on this syndrome written from the perspective of the emergency physician. ⋯ The acute complications of refeeding syndrome may present during a patient's stay in the ED or during the transition from the ED to a critical care area, and thus this syndrome deserves consideration from the moment a starved patient presents to our triage desks.