J Emerg Med
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Thyrotoxic periodic paralysis is rare in Caucasian populations, but affects approximately 2% of East Asians with thyrotoxicosis (13% of males, 0.17% of females). The presentation is characterized by abrupt-onset hypokalemia and profound proximal muscular weakness, and commonly occurs after carbohydrate loading or exercise. ⋯ It may be important to check thyroid function in patients presenting with acute paralysis, especially those of Asian origin. In patients with thyrotoxic periodic paralysis, administration of potassium, with cardiac monitoring and a total dose of <50 mmol, limits the dysrhythmia risk. Patients are likely to benefit from the prescription of non-selective beta-blockers until they become euthyroid. In contrast to familial periodic paralysis, regular oral potassium supplementation is ineffective in thyrotoxic periodic paralysis, and acetazolamide precipitates, rather than prevents, attacks.
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Antihypertensive medications, including β-blockers, are widely used in patients with chronic kidney disease. Unlike most β-blockers, atenolol is excreted primarily by the kidney, and its clearance by peritoneal dialysis is poor. These pharmacokinetic factors may predispose patients to gradual accumulation of the drug over time. ⋯ The unique pharmacokinetics of long-term medications must be considered in patients with impaired clearance, such as this patient with end-stage renal disease treated by peritoneal dialysis. Medications may gradually accumulate to supratherapeutic levels, which over time may lead to symptoms of significant toxicity.
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The kidney is the third most common solid organ injury in blunt abdominal trauma. The preferred treatment of blunt kidney injury varies according to grade of severity, with a preference for non-operative management in most instances. ⋯ Our patient was managed medically despite his high grade of injury. This article reviews the diagnosis and management of blunt renal trauma and highlights the fact that despite significant injury, a patient can go on to do well with conservative management alone.
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Emergency Department (ED) overcrowding and ensuing concern about patients who leave without treatment have become a mounting national concern. In addition, the Centers for Medicaid and Medicare Services released regulatory standards for EDs requiring reporting of time from initial triage to decision to admit, as well as actual time of admission. ⋯ Our study demonstrated that a tailored ED redesign process can dramatically decrease the time to provider, ALOS, and LWOT rates.
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Department of Radiology performed ultrasound for patients suspected of having intussusception in resource-limited settings might be either unavailable or significantly time delayed. ⋯ In resource-limited settings, point-of-care ultrasound performed by a physician trained to diagnose intussusception can reduce the time to definitive management and thereby potentially reduce complications such as bowel ischemia and necrosis, dehydration, and sepsis.