J Emerg Med
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The cause of a pediatric out-of-hospital cardiac arrest (OHCA) may go unexplained in the emergency department setting but can be secondary to a toxicologic etiology. It is unclear how toxicologic screens are used in the postarrest period after a pediatric OHCA. ⋯ Our study found that in pediatric OHCA, toxicologic screens were completed but were not routinely sent in our institution. There may be factors such as clinician bias or the severity of a patient's illness that impact the approach to toxicologic screening in pediatric OHCA. In addition to the history and physical examination, emergency physician and pediatric intensivists should consider routinely sending toxicologic screens to assist in uncovering any accidental or malicious explanation for the event.
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Households are increasingly stockpiling and producing hand sanitizer amid the coronavirus disease 2019 (COVID-19) pandemic, which can pose an increased risk for unintentional toxicity among children. Despite guidelines for hand sanitizer production published by the World Health Organization, many turn to streaming media for instruction. ⋯ YouTube may not be an accurate source for effective hand sanitizer concoction. Health care providers and parents should be aware of the increased surge in hand sanitizer exposure among children and should take proper precautionary measures.
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Myocarditis is a rare sequelae of acute myeloid leukemia (AML) and typically presents after the initial diagnosis of AML has been made. ⋯ We present the case of a 37-year-old female who came to the emergency department with chest pain, ST elevations on electrocardiogram, and a positive point-of-care troponin. She was brought emergently to the cardiac catheterization laboratory. After a negative catheterization, blasts were noted on the complete blood count, ultimately leading to the diagnosis of AML, with myopericarditis as the presenting manifestation. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: This case highlights the need for emergency physicians to consider a broad differential for chest pain, especially in those who do not fit into the prototypical patient with acute coronary syndrome.
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Some experts recommend using a 1-h sepsis bundle, but clinical data supporting this strategy are lacking. ⋯ In a group of code sepsis patients from facilities that use a 1-h sepsis bundle, the majority were ultimately not diagnosed with sepsis, and nearly half did not have a bacterial infection. A small minority of patients had bacteremia. Restricting blood culture ordering in patients with possible sepsis to only those who have increased risk for bacteremia could lead to a more judicious use of blood cultures.
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Emergency departments (EDs) worldwide experience substantial variability in hourly patient arrivals. The month of Ramadan represents a repetitive annual occurrence, which could be associated with distinct patient arrival patterns compared with other months of the year. ⋯ We found a drop in daily ED visits during Ramadan, in addition to a distinct pattern of patient arrivals. ED administrators should consider different scheduling arrangements for nurses and physicians during this period in EDs that serve communities where Ramadan is commonly observed.