ABC/2 estimation in intracerebral hemorrhage: A comparison study between emergency radiologists and emergency physicians.

OBJECTIVES: We aimed to define levels of agreement (LOA) between emergency radiologists (RAD) and emergency medicine (EM) physicians for estimating bleed volume in intracranial hemorrhages (ICH) using ABC/2 formula. METHODS: A prospective study of a curated sample of head CT's were performed in an emergency department. Raters independently reviewed the scans. Perpendicular maximal dimensions (A and B) were measured on an axial CT image. The 'C' dimension was a product of slice thickness and number of slices with visible bleed. RESULTS: A hundred CT head examinations were included with a median age of 50 years (IQR 43 to 57). The median bleed volume was 11.2 mL (IQR 6.6-18.6) per the index radiologist estimations. The overall mean of differences between the RAD mean and the EM mean estimated bleed volume was 0.3 (95% CI -1.5 to +1.7) in milliliters. The percentage difference between EM and RAD expressed as median was 1.9% (IQR -13.4% to +14.1%). Compared to the index RAD the mean of differences for bleed volume [rater, mean (95% CI) in milliliters] were: second RAD, 1.19 (1.14 to 1.24); EM attending, 1.05 (0.98 to 1.13); senior fellow, 1.05 (1.00 to 1.10); junior fellow, 1.19 (1.06 to 1.33); senior resident, 1.29 (1.19 to 1.39); junior resident, 1.11 (1.03 to 1.20). The difference between EM versus radiologist, junior versus senior EM physician estimation of bleed size was clinically insignificant. CONCLUSIONS: Excellent level of agreement was found between emergency physicians and emergency radiologists for estimating ICH bleed volumes using ABC/2 formula.

Severe Persistent Hyperkalemia with Electrocardiogram Changes in a Patient with Hyperaldosteronism.

A 62-year-old female presented to the emergency department (ED) with fatigue and generalized body weakness for the last three days. Upon arrival, initial ECG showed wide complex tachycardia with sine waves and a heart rate (HR) ranging between 100-170 bpm. She was otherwise vitally stable. The patient had a past medical history of hyperaldosteronism, type 2 diabetes mellitus (DM), chronic kidney disease (CKD) with microalbuminuria, and hypertension. She also had a history of cerebrovascular accident (CVA) and residual left-sided weakness more pronounced in the upper limb. Initial venous blood gas (VBG) analysis showed a potassium level of more than 10 mmol/L, chloride 114 mmol/L, bicarbonate 9 mmol/L, sodium 135 mmol/L, and pH of 7.1. Treatment for hyperkalemia was started immediately with calcium gluconate 1 gm that effectively narrowed her QRS complex and normalized her ECG. Salbutamol nebulization, glucose/insulin infusion, and calcium polystyrene syrup were given. Later, she was started on 100 mg sodium bicarbonate infusion, and Foley's catheter was inserted to follow urine output (UOP) strictly. However, she did not show a decrease in serum potassium levels. Then the patient underwent hemodialysis for two hours. Her first potassium reading after hemodialysis was 5.2 mmol/L. The purpose of this case report is to emphasize the importance of hemodialysis in patients with persistent severe life-threatening hyperkalemia.