J Emerg Med
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Observational Study
Agreement Between Resident and Faculty Emergency Physicians in the Application of NEXUS Criteria for Suspected Cervical Spine Injuries.
The National Emergency X-Radiography Utilization Study (NEXUS) developed a decision rule for when cervical spine radiographs are required in the setting of trauma. To our knowledge, inter-rater reliability between resident and faculty emergency physicians has not been studied. ⋯ Based on our findings, there was considerable difference in agreement between staff physicians and residents. This could be due to the level of experience of the provider or the subjectiveness of components the criteria.
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Observational Study
The Contributions of Emergency Physicians to Out-of-hospital Cardiopulmonary Arrest: An Analysis of the National Utstein Registry Data.
Emergency physicians are likely to play an important role in the "chain of survival." The relationship between the number of emergency physicians and out-of-hospital cardiopulmonary arrest (OHCA) prognosis is not well understood. ⋯ An increased number of emergency physicians/100,000 population is likely to be associated with improved outcomes.
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Case Reports
Profound Symptomatic Bradycardia Requiring Transvenous Pacing After a Single Dose of Tizanidine.
We report a case of profound symptomatic bradycardia after a single dose of tizanidine. ⋯ Tizanidine should be used cautiously in elderly population and drug interactions screening should be performed.
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Rhabdomyolysis, usually in the setting of trauma or drug use, is frequently seen in the emergency setting, and often leads to hyperkalemia at presentation. Hypokalemia, however, is a potentially underrecognized cause of rhabdomyolysis. ⋯ We present a case of rhabdomyolysis likely due to hypokalemia in the setting of short bowel syndrome. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Although less common, hypokalemia can be a significant cause of rhabdomyolysis via its effects on muscle. This scenario should be considered in the differential diagnosis of patients at risk for hypokalemia who present with weakness. Rapid recognition of this relationship and rapid correction of hypokalemia may prove very important in preventing the deleterious effects of rhabdomyolysis.
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Case Reports
An Uncommon Cause of Acute Back Pain: Spinal Subarachnoid Hemorrhage Progressing to Spinal Cord Compression.
Spinal subarachnoid hemorrhage (SSH) is an uncommon occurrence responsible for <1% of all cases of subarachnoid hemorrhage (SAH). ⋯ We present the case of a 53-year-old man who presented to the emergency department (ED) with acute onset of "tearing" back pain that began during activity, and who was diagnosed with an SSH that ultimately progressed to spinal cord compression. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Although uncommon, the consequences of SSH are potentially devastating, yet reversible, making awareness of this condition critical. Several rare yet potentially devastating causes of acute back pain are deserving of consideration when approaching back pain in the ED setting; SSH is among them. Pain that is described as "tearing" or that is unresponsive to ordinary analgesic dosages should prompt strong consideration of vascular or other serious pathology, including arterial dissection or spinal cord compression.