ABSTRACT
Deep vein thrombosis (DVT) can present with a variety of nonspecific signs and symptoms, and can involve the upper or lower extremities. Management of patients with DVT has changed markedly over the last 10 years, moving from hospital admission for initiation of anticoagulation to outpatient management. Diagnosis requires a risk stratification process involving clinical decision rules, D-dimer testing, and ultrasonography. Once the diagnosis is confirmed, the patient should be engaged in shared decision-making regarding treatment options. Recurrent DVT, as well as managing DVT in pregnant women, the elderly population, and patients with malignancies are also discussed.
Subject(s)
Emergency Service, Hospital , Venous Thrombosis/diagnosis , Venous Thrombosis/therapy , Anticoagulants/therapeutic use , Biomarkers/metabolism , Compression Bandages , Diagnosis, Differential , Diagnostic Imaging , Evidence-Based Emergency Medicine , Fibrin Fibrinogen Degradation Products/metabolism , Humans , Risk Factors , Vena Cava FiltersABSTRACT
Hypokalemia and hyperkalemia are the most common electrolyte disorders managed in the emergency department. The diagnosis of these potentially life-threatening disorders is challenging due to the often vague symptomatology a patient may express, and treatment options may be based upon very little data due to the time it may take for laboratory values to return. This review examines the most current evidence with regard to the pathophysiology, diagnosis, and management of potassium disorders. In this review, classic paradigms, such as the use of sodium polystyrene and the routine measurement of serum magnesium, are tested, and an algorithm for the treatment of potassium disorders is discussed.
Subject(s)
Disease Management , Emergency Service, Hospital , Evidence-Based Medicine , Hyperkalemia/diagnosis , Hyperkalemia/therapy , Hypokalemia/diagnosis , Hypokalemia/therapy , Acid-Base Imbalance/diagnosis , Acid-Base Imbalance/physiopathology , Acid-Base Imbalance/therapy , Algorithms , Diagnosis, Differential , Electrocardiography , Humans , Hyperkalemia/physiopathology , Hypokalemia/physiopathology , Water-Electrolyte Imbalance/diagnosis , Water-Electrolyte Imbalance/physiopathology , Water-Electrolyte Imbalance/therapyABSTRACT
Hypokalemia and hyperkalemia are the most common electrolyte disorders managed in the emergency department. The diagnosis of these potentially life-threatening disorders is challenging due to the often vague symptomatology a patient may express, and treatment options may be based upon very little data due to the time it may take for laboratory values to return. This review examines the most current evidence with regard to the pathophysiology, diagnosis, and management of potassium disorders. In this review, classic paradigms, such as the use of sodium polystyrene and the routine measurement of serum magnesium, are tested, and an algorithm for the treatment of potassium disorders is discussed. [Points & Pearls is a digest of Emergency Medicine Practice].
Subject(s)
Emergency Service, Hospital , Evidence-Based Medicine , Hyperkalemia , Hypokalemia , Acid-Base Imbalance/diagnosis , Acid-Base Imbalance/physiopathology , Acid-Base Imbalance/therapy , Cation Exchange Resins/therapeutic use , Disease Management , Hematologic Tests/methods , Humans , Hyperkalemia/diagnosis , Hyperkalemia/physiopathology , Hyperkalemia/therapy , Hypokalemia/diagnosis , Hypokalemia/physiopathology , Hypokalemia/therapy , Magnesium/blood , Water-Electrolyte Imbalance/diagnosis , Water-Electrolyte Imbalance/physiopathology , Water-Electrolyte Imbalance/therapyABSTRACT
BACKGROUND: Infectious mononucleosis, caused by the Epstein-Barr virus (EBV), is a common infection with worldwide distribution; more than 90% of people have been infected by adulthood. One of the most feared, albeit rare, complications, occurring in less than 0.5% of those infected, is splenic injury or rupture. CASE REPORT: A febrile 15-year-old male presented to the emergency department with the chief compliant of headache, neck pain, and upper shoulder pain. He did not recall any specific traumatic injury. His abdomen was soft, nondistended, and was tender in the right and left lower quadrants. Right lower quadrant ultrasound demonstrated non-visualization of the appendix, moderate right lower quadrant free fluid, and positive McBurney's sign. CT of the abdomen and pelvis was ordered, which demonstrated moderate splenomegaly, with findings compatible with laceration through the anterior aspect of the spleen, with moderate hemoperitoneum. Monospot was negative and EBV panel demonstrated IGG negative, IGM positive, and, IGG negative. The patient was transferred to interventional radiology for a splenic angiogram and proximal splenic artery embolization. The angiogram demonstrated grade 3 laceration with moderate hemoperitoneum and no active extravasation or evidence of pseudoaneurysm. The patient was admitted and made a prompt recovery without any other sequelae. CONCLUSIONS: The presentation of splenic injury or rupture can vary; the patient may complain of abdominal pain or left upper quadrant pain, may exhibit referred left shoulder pain when the LUQ is palpated (Kehr's Sign), or may exhibit hemodynamic instability. Given the spectrum of non-specific symptoms, diagnosing EBV-induced splenic laceration can be difficult.