J Emerg Med
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Risk factors for exacerbation of congestive heart failure have not been consistently validated. ⋯ Patients with chronic congestive heart failure who presented to the Emergency Department with acute decompensated heart failure were no more likely to report consuming a greater number of high-sodium foods in the 3 days before than were patients with chronic congestive heart failure who presented with unrelated symptoms. On the other hand, those who presented with acute decompensated heart failure were significantly more likely to report nonadherence with medications.
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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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Interphalangeal joint dislocations of toes are relatively rare and can generally be treated by closed reduction. ⋯ Even such a minor trauma as a lesser toe injury deserves thorough physical examination, and when indicated on radiological imaging, as significant injuries can easily be overlooked.
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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.
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Case Reports
An unusual case of hypotension after fibrinolysis resulting from mediastinal hemorrhage.
Although bleeding complications may occur after fibrinolysis, mediastinal hemorrhage is extremely rare. ⋯ As fibrinolysis remains a common means of establishing reperfusion in patients with acute MI, emergency physicians should be aware of such unusual complications secondary to fibrinolysis. An orderly clinical approach with an individualized management protocol is essential in such situations so that undue instrumentation and invasive procedures with their attendant risks in a thrombolysed patient are avoided.