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1.
Emerg Med Clin North Am ; 32(2): 349-66, 2014 May.
Article in English | MEDLINE | ID: mdl-24766937

ABSTRACT

Derangements of calcium, magnesium, and phosphate are associated with increased morbidity and mortality. These minerals have vital roles in the cellular physiology of the neuromuscular and cardiovascular systems. This article describes the pathophysiology of these mineral disorders. It aims to provide the emergency practitioner with an overview of the diagnosis and management of these disorders.


Subject(s)
Calcium/metabolism , Critical Illness , Emergency Service, Hospital , Magnesium/metabolism , Metabolic Diseases , Phosphates/metabolism , Homeostasis/physiology , Humans , Incidence , Metabolic Diseases/epidemiology , Metabolic Diseases/metabolism , Metabolic Diseases/therapy
2.
J Emerg Med ; 44(5): 1045-53, 2013 May.
Article in English | MEDLINE | ID: mdl-23352866

ABSTRACT

BACKGROUND: The diagnosis of subarachnoid hemorrhage is of paramount concern in patients presenting to the Emergency Department (ED) with acute headache. Computed tomography followed by lumbar puncture is a time-honored practice, but recent technologic advances in magnetic resonance imaging with magnetic resonance angiography and computed tomography with computed tomography angiography can present alternatives for clinicians and patients. OBJECTIVE: The aim of this article was to compare diagnostic strategies for ED patients in whom subarachnoid hemorrhage is suspected. METHODS: We analyze and discuss current protocols, in addition to summarizing the advantages and disadvantages of each method. RESULTS: Through our residency's journal club, we organized an evidence-based debate that pitted proponents of the three subarachnoid hemorrhage diagnostic strategies against one another. Proponents of each strategy described its advantages and disadvantages. Briefly, computed tomography/lumbar puncture is time honored and effective, but is limited by complications and indeterminate lumbar puncture results. Magnetic resonance imaging with magnetic resonance angiography might be more effective in late presentations and can visualize aneurysms, yet has limited availability. Computed tomography with computed tomography angiography offers rapid diagnosis and is considered the most sensitive for diagnosing aneurysms, but has the highest radiation exposure. CONCLUSIONS: Each of the three strategies used to diagnose subarachnoid hemorrhage has advantages and disadvantages with which clinicians should be familiar. Patient factors (e.g., age, body habitus, and risk factors), presentation factors (e.g., time from headache onset and severity of presentation), and institutional factors (availability of magnetic resonance imaging with magnetic resonance angiography) can influence the choice of protocol.


Subject(s)
Subarachnoid Hemorrhage/diagnosis , Brain/pathology , Diagnostic Imaging/methods , Emergency Medicine , Emergency Service, Hospital , Evidence-Based Medicine , Humans , Intracranial Aneurysm/diagnosis , Sensitivity and Specificity , Spinal Puncture
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