J Emerg Med
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Early initiation of a new P2Y12 inhibitor in ST-elevation myocardial infarction (STEMI) patients prior to primary percutaneous coronary intervention (PCI) is recommended over clopidogrel. However, comparative data remain limited, especially in semi-rural regions with subsequent longer transfer times. ⋯ Compared with clopidogrel, pretreatment with new P2Y12 inhibitors seems to be associated with lower risks of mortality and ischemic outcomes, and similar risks of bleeding in a real-world registry. Our results are in line with the guidelines recommending the preferential pre-PCI administration of new P2Y12 inhibitors in STEMI patients referred for primary PCI.
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Coronavirus disease 2019 (COVID-19) is associated with respiratory symptoms and renal effects. Data regarding fluid resuscitation and kidney injury in COVID-19 are lacking, and understanding this relationship is critical. ⋯ Each liter of intravenous fluid administered to patients with COVID-19 in the first 24 h of presentation was independently associated with an increased risk for initiation of renal replacement therapy, supporting judicious fluid administration in patients with this disease.
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Priapism can be categorized as low flow or high flow. Low flow priapism is a compartment syndrome and requires immediate treatment to avoid long-term ischemic damage. Alternatively, high flow priapism is not an emergent condition and can be managed as an outpatient. The diagnosis has traditionally been made via cavernosal blood gas analysis; however, this is painful and can cause iatrogenic harm. ⋯ We present a case of high flow priapism whereby point-of-care ultrasound (POCUS) identified the presence of pulsatile cavernosal arterial flow to confirm the diagnosis. This is the first case report in the emergency medicine literature to highlight the utility of POCUS in the diagnosis and management of high flow priapism. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Low flow priapism accounts for 95% of cases and is a urologic emergency requiring immediate invasive intervention. High flow priapism is much less common and does not require emergent management. While blood gas analysis can differentiate between high and low flow priapism, POCUS is a rapid, noninvasive, accurate diagnostic means to identify the presence or absence of cavernosal pulsatile arterial flow.
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Opioid-induced constipation (OIC) is a frequent consequence of opioid analgesia that may increase patient risk for emergency department visits and hospitalization. Methylnaltrexone is a peripherally acting µ-opioid receptor antagonist indicated for the treatment of OIC. ⋯ Methylnaltrexone provides early RFL without compromising analgesia in patients receiving chronic opioid therapy.