J Emerg Med
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In 2011, the American Academy of Pediatrics revised practice parameters regarding febrile urinary tract infection (fUTI) in children aged 2-24 months. The Section on Urology opposed the omission of voiding cystourethrogram (VCUG), and expressed concern that potential untoward consequences of deferring VCUG may be most felt by children on Medicaid. ⋯ Abnormal ultrasound, non-Hispanic race, and public insurance were strongly associated with hospital admission in children presenting to the ED with initial febrile urinary tract infection.
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Observational Study
Efficacy of Noncontrast Computed Tomography of the Abdomen and Pelvis for Evaluating Nontraumatic Acute Abdominal Pain in the Emergency Department.
Computed tomography (CT) clarity has significantly improved since it became widely available in the early 1980s, making the utility and benefit of contrast material for image quality of the abdomen and pelvis uncertain, and so far, minimally studied. ⋯ With certain inclusion and exclusion criteria, noncontrast CT of the abdomen and pelvis is likely a reliable diagnostic modality for the evaluation of acute nontraumatic abdominal pain in the ED.
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Prescription opioid abuse and overdose has steadily increased in the United States (US) over the past two decades, and current research has shown a dramatic increase in hospitalizations resulting from opioid poisonings. Still, much is unknown about the clinical and demographic features of patients presenting to emergency departments (EDs) for poisoning from prescription drugs. ⋯ There were over 250,000 visits to US EDs from 2006 through 2011 with a primary diagnosis of poisoning by a prescription opioid. Females made the majority of visits, and over half were admitted to the hospital, resulting in over $4 billion in charges. Future studies should examine preventative measures, optimal screening, and intervention programs for these patients.
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Brugada pattern (BrP) findings on electrocardiogram (ECG) are mandatory for the diagnosis of Brugada syndrome (BrS). BrS is an incompletely understood cause of sudden cardiac death. ⋯ Our patient was a young woman who was using topical nicotine for assistance in smoking cessation at a relatively high dose compared to her daily cigarette intake. She presented with symptoms of mild nicotine toxicity and had an ECG with a type 1 BrP. An ECG the next day was normal and electrophysiology consultation was conducted. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Recognition of a BrP ECG by emergency physicians is critical because this is the first step in diagnosing BrS, a condition that is characterized by ventricular dysrhythmias and sudden cardiac death. In addition, ECG abnormalities can be transient in nature, requiring vigilance by the emergency physician to prevent the patients' potential life threat from going undiagnosed. We present the first case to our knowledge of a BrP associated with nicotine toxicity. We also discuss treatment and disposition recommendations.
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A 29-year-old man was lost in the bush with minimal clothing for almost 2 days. ⋯ The patient in this case developed rhabdomyolysis with subsequent acute kidney injury. He was treated with passive warming and intravenous fluids, with resolution of the kidney injury. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Patients who present with hypothermia may develop rhabdomyolysis with subsequent acute kidney injury. If not identified, renal failure may develop. This is easily preventable if the practitioner is aware of the possible consequences of cold exposure, orders the appropriate test, and administers corrective treatment.