J Emerg Med
-
Transthoracic echocardiography (TTE) is an essential tool for risk-stratifying patients with pulmonary embolism (PE), but its availability is limited, often requiring hospitalization. Minimal research exists evaluating clinical and laboratory criteria to predict lack of abnormal TTE findings. ⋯ The PEACE (Pulmonary Embolism and Abnormal Cardiac Echocardiogram) criteria, composed of six variables, is highly effective in predicting abnormal TTE in patients with PE, potentially identifying who is safe for early discharge from the hospital.
-
As emergency physicians are looking at handheld devices as alternatives to the traditional, cart-based systems, concerns center around whether they are forsaking image quality for a lower price point and whether the handheld can be trusted for medical decision making. ⋯ Data support that it is feasible to use the handheld ultrasound device for evaluation of the trauma patient in place of the cart-based system.
-
Phenobarbital has been used in the emergency department (ED) as both a primary and adjunctive medication for alcohol withdrawal, but previous studies evaluating its impact on patient outcomes are limited by heterogenous symptom severity. ⋯ Patients who received phenobarbital for moderate alcohol withdrawal were more likely to be admitted to the hospital, but there was no difference in admission level of care when compared with patients who received benzodiazepines alone. Patients who received phenobarbital were provided greater lorazepam equivalents in the ED.
-
Hyperkalemia is a common electrolyte abnormality that requires urgent treatment. Insulin is an effective treatment for hyperkalemia, but risk factors for developing insulin-induced hypoglycemia exist (e.g., low pretreatment glucose or renal impairment). ⋯ A hyperkalemia protocol update was not associated with a significant reduction in hypoglycemia, and the incidence of hypoglycemia remained higher than anticipated. Future studies attempting to optimize treatment in this high-risk population are warranted.
-
Multiple sclerosis (MS) is a rare but serious condition associated with significant morbidity. ⋯ An understanding of MS can assist emergency clinicians in better diagnosing and managing this neurologically devastating disease.