Archive for category: Clinical

ECG Changes of Hyperkalemia

17 Apr
April 17, 2014

Hyperkalemia is an electrolyte abnormality seen in the emergency department as well as in hospitalized patients and it can be associated with adverse clinical outcomes and death if not treated appropriately. It is important to remember that the electrophysiologic effects of hyperkalemia are directly proportional to both the absolute plasma potassium and its rate of […]

Diagnosis of Right Ventricular Strain with Transthoracic Echocardiography

07 Apr
April 7, 2014

Abnormal vital signs are poor predictors of mortality associated with pulmonary embolism (PE).  Diagnosis of PE and right ventricular (RV) strain with transthoracic echocardiography (TTE) however, has been well documented as a predictor for pending shock and significant in-hospital mortality.  One study done by Grifoni S et al, showed that 10% of normotensive patients with […]

tPA-associated Angioedema

03 Apr
April 3, 2014

For the most part, the biggest concern with administering tPA is the bleeding complications, specifically intracranial hemorrhage. But there is another side effect that is being reported more frequently. I, myself, saw two cases in one week. This side effect is tPA-associated angioedema. Case: A 70-year-old female with a past medical history of hypertension and […]

Post Lumbar Puncture Headaches

31 Mar
March 31, 2014

Lumbar puncture is a procedure that is commonly performed in the emergency department (ED) for both diagnostic and therapeutic reasons. Post lumbar puncture (LP) headache is one of the most common complications from LPs (6 – 36% incidence) and is essentially a clinical diagnosis based on a history of a dural puncture and the postural nature of the […]

Is There Any Benefit to an Initial Insulin Bolus in Diabetic Ketoacidosis?

27 Mar
March 27, 2014

Diabetic ketoacidosis (DKA) is a common endocrine emergency encountered in the emergency department.  DKA associated mortality is relatively low in adults, but in children with type 1 diabetes, the elderly, and adults with concomitant illnesses have a mortality rate is > 5% .  Guidelines for the management of hyperglycemic crisis in adults provide recommendations for intravenous […]

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