Journal of community hospital internal medicine perspectives
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J Community Hosp Intern Med Perspect · Jan 2011
The utility of the initial electrocardiogram in predicting acute coronary events in current cocaine users with chest pain in the emergency department.
Chest pain suggestive of myocardial ischemia or infarction is a common emergency department complaint and a subset of these is associated with cocaine use. It can be difficult to triage patients with chest pain while using cocaine. ⋯ The initial ECG with a good clinical history can be used effectively to triage patients presenting with chest pain and current use of cocaine in the emergency department.
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This article focuses on the pathogenesis, clinical manifestations, and various treatment modalities for acute hyperkalemia and presents a systematic approach to selecting a treatment strategy. Hyperkalemia, a life-threatening condition caused by extracellular potassium shift or decreased renal potassium excretion, usually presents with non-specific symptoms. Early recognition of moderate to severe hyperkalemia is vital in preventing fatal cardiac arrhythmias and muscle paralysis. ⋯ Treatment should be started with calcium gluconate to stabilize cardiomyocyte membranes, followed by insulin injection, and b-agonists administration. Hemodialysis remains the most reliable method to remove potassium from the body and should be used in cases refractory to medical treatment. Prompt detection and proper treatment are crucial in preventing lethal outcomes.