Journal of Emergency Medicine最新文献

{"title":"Parsing Out Potential Language Barriers for Their Effects on Imaging","authors":"Neeraj Chhabra MD, MSCR , Errick Christian MS , Lum Rizvanolli BS","doi":"10.1016/j.jemermed.2024.02.010","DOIUrl":"https://doi.org/10.1016/j.jemermed.2024.02.010","url":null,"abstract":"","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141241152","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Presentation and characteristics of patients with suspicion of cancer presenting to an oncologic emergency department","authors":"Monica K Wattana MD ,&nbsp;Mark McIntyre MD ,&nbsp;Adriana Wechsler MD ,&nbsp;Patricia A. Brock MD ,&nbsp;Faith Dupler ,&nbsp;Sai-Ching J. Yeung MD, PhD ,&nbsp;Aiham Qdaisat MD","doi":"10.1016/j.jemermed.2024.03.028","DOIUrl":"https://doi.org/10.1016/j.jemermed.2024.03.028","url":null,"abstract":"<div><h3>Introduction</h3><p>Patients with a known cancer diagnosis are frequent visitors to general emergency departments (ED) Since MD Anderson Cancer Center is a dedicated oncologic hospital, new patients present with symptoms suspected to be attributable to a yet unconfirmed cancer diagnosis. The aim was to examine and characterize the oncologic ED presentation of new patients with a suspicion of cancer.</p></div><div><h3>Methods</h3><p>Our institutional database was quired for all ED visits for subjects aged 18 and older with no prior cancer diagnosis (using tumor registry and billing database) between 11/1/2020 and 01/01/2022. Chart review was conducted to confirm the absence of previous cancer diagnosis in the identified subjects and to verify they received follow-up in our institution. Demographics, ED presentation and clinical data were collected. Descriptive statistics and Chi-Square test of independence were used to analyze, compare and report the presentation and the outcomes of final eligible patients.</p></div><div><h3>Results</h3><p>During the study period, of the 2727 subjects identified, 358 met the final eligibility criteria. The median age was 57 years (interquartile range: 45-66 years). The majority were male (51.1%), White or Caucasian race (57.0%) and not Hispanic or Latino ethnicity (74.0%). Almost all the patients (99.2%) were presented as emergent or urgent acuity level (i.e., Emergency Severity Index levels 2 or 3 respectively). The most frequent presenting complaint(s) were: Abnormal laboratory results (16.8%); Hypertension (9.8%); infection and/or suspected sepsis (7.5%); nausea/vomiting (7.3%); fatigue (7.0%); shortness of breath (6.7%) or headache (5.9%). Most of the patients were admitted either to the hospital (59.2%) or the observation unit (18.2%). Of the 212 admitted patients, 35 (16.5%) died within one year of the ED presentation, which was significantly (P=0.003) higher than the 5.5% one-year mortality rate for the patients who were discharged or placed in the observation unit.</p></div><div><h3>Conclusion</h3><p>Most patients presenting to an oncologic emergency with unconfirmed suspicion of cancer require hospitalization. The admitted group have higher mortality for reasons that need further elucidation. Further research is also needed to understand why the fairly large segment that do not require hospitalization seek care in the ED setting.</p></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141243281","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"American Academy of Emergency Medicine","authors":"","doi":"10.1016/S0736-4679(24)00187-2","DOIUrl":"https://doi.org/10.1016/S0736-4679(24)00187-2","url":null,"abstract":"","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0736467924001872/pdfft?md5=3ae8da273fc9fef5df61d95745df72bf&pid=1-s2.0-S0736467924001872-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141240969","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Danger of Inferior Auscultation Tools","authors":"W. Frank Peacock MD, FACEP, FACC, FESC","doi":"10.1016/j.jemermed.2024.03.027","DOIUrl":"https://doi.org/10.1016/j.jemermed.2024.03.027","url":null,"abstract":"<div><h3>Background</h3><p>The potential for heart failure, and thus the need for accurate auscultation, represents real risks in patients undergoing certain specific cancer treatments. As the need to prevent pathogen exposure by unclean stethoscopes cannot be addressed by simply washing the diaphragm with alcohol (leaving pathogens in as many as 28%), strategies to protect the immunocompromised patient have included single use aseptic diaphragm barriers, or single patient used disposable stethoscopes. Since the auscultation quality of these strategies are poorly described, we sought to determine their diagnostic accuracy in identifying potential cardiovascular sounds of heart failure.</p></div><div><h3>Methods</h3><p>Using a simulation mannequin, we performed a prospective randomized trial to determine the ability of physicians to identify sounds using the following auscultation strategies: a single patient use disposable stethoscope (Proscope 665, ADC Inc, Hauppauge, New York), a high fidelity Littman 3200 recording stethoscope (3M, Inc, St. Paul, MN), and a high fidelity Littman 3200 recording stethoscope with a DiskCover barrier (Aseptiscope, Inc, San Diego, CA) in place. Physicians, randomized to auscultation strategy, performed blinded auscultation on a simulation mannequin to identify various sounds.</p></div><div><h3>Results</h3><p>Overall, 28 physicians performed 910 auscultation examinations. A total of 800 were performed using the Littman 3200 stethoscope (400 with, and 400 without, the DiskCover barrier), and 110 auscultations using the single patient disposable stethoscope. Diagnostic accuracy was 100% with the Littman stethoscope, with identical accuracy with or without the DiskCover barrier in place. When using the disposable stethoscope there were 12 diagnostic errors; a 10.9% error rate. All single use stethoscope diagnostic errors were of heart murmurs (9 systolic and 3 diastolic).</p></div><div><h3>Conclusions</h3><p>The disposable single patient stethoscope used in this study resulted in a potential misdiagnosis number needed harm of 10 and suggests these inferior tools should not be used in patients. Using a high fidelity stethoscope with a disposable barrier was acoustically invisible, provided 100% diagnostic accuracy, and provided an aseptic patient contact.</p></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141243279","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Emergency department observational unit usage by patients with cancer: A retrospective review","authors":"Jasmine King MA ,&nbsp;Jason J. Bischof MD ,&nbsp;Lauren T. Southerland MD","doi":"10.1016/j.jemermed.2024.03.024","DOIUrl":"https://doi.org/10.1016/j.jemermed.2024.03.024","url":null,"abstract":"<div><h3>Background</h3><p>Emergency department observation units (EDOUs) are effective and increasingly utilized in the delivery of short-term care. These units decrease length of stay and cost while increasing patient satisfaction and safety. Currently, EDOUs are underutilized for patients with cancer. We aimed to characterize the care of patients with cancer in an academic type 1 EDOU.</p></div><div><h3>Methods</h3><p>Retrospective review of EDOU quality data at an academic medical center with a Comprehensive Cancer Center (CCC). Eligible encounters included patients ≥ 18 cared for in the EDOU between July 1, 2019, and December 31, 2022. Patients with cancer were identified using an oncology triage screen during ED intake defined as a self-report of an active cancer or receiving care at the associated CCC. Descriptive statistics were employed to describe demographics, chief complaint, and assigned EDOU protocol. Pearson's chi-squared test was performed to determine statistically significant differences among patients with and without cancer. Due to dataset limitations, it was impossible to remove EDOU subjects with cancer treated for noncancer-related reasons.</p></div><div><h3>Results</h3><p>From 15,089 eligible EDOU encounters, 1,711 (11.3%) involved patients with cancer – 348, 548, 444, and 371 visits in 2019, 2020, 2021, and 2022 respectively. In the cohort with cancer, most patients were White (1,353, 79.1%) with a slight female predominance (905, 52.9%) noted. Furthermore, unspecified (148, 8.6%), chest pain (127, 7.4%), and abdominal pain (93, 5.4%) were the top chief complaints. In patients with cancer, 1,234 (72.1%) encounters resulted in discharge, significantly lower than that observed in patients without cancer (10,408, 77.8%; p&lt;0.001). In both groups, the general observation protocol was the most utilized order set. However, further analysis revealed a significantly increased use of the general observation protocol in patients with cancer compared to noncancer patients (25.4% and 14.0%, respectively; p&lt;0.001).</p></div><div><h3>Conclusions</h3><p>Compared to patients without cancer, patients with cancer experience a significantly higher use of the general observation protocol suggesting that further optimization and development of novel cancer-specific EDOU protocols is warranted.</p></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141243276","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessment of Outcomes in Patients with Heart Failure and End-Stage Kidney Disease after Fluid Resuscitation for Sepsis and Septic Shock","authors":"John Michael Herndon PharmD ,&nbsp;Sarah B. Blackwell PharmD ,&nbsp;Nathan Pinner PharmD ,&nbsp;Thomas S. Achey PharmD, MS ,&nbsp;Hillary B. Holder PharmD ,&nbsp;Cruz Tidwell PharmD","doi":"10.1016/j.jemermed.2024.02.001","DOIUrl":"10.1016/j.jemermed.2024.02.001","url":null,"abstract":"<div><h3>Background</h3><p>Sepsis fluid resuscitation is controversial, especially for patients with volume overload risk. The Surviving Sepsis Campaign recommends a 30-mL/kg crystalloid fluid bolus for patients with sepsis-induced hypoperfusion. Criticism of this approach includes excessive fluid resuscitation in certain patients.</p></div><div><h3>Objective</h3><p>The aim of this study was to assess the efficacy and safety of guideline-concordant fluid resuscitation in patients with sepsis and heart failure (HF) or end-stage kidney disease (ESKD).</p></div><div><h3>Methods</h3><p>A retrospective cohort study was conducted in patients with sepsis who qualified for guideline-directed fluid resuscitation and concomitant HF or ESKD. Those receiving crystalloid fluid boluses of at least 30 mL/kg within 3 h of sepsis diagnosis were placed in the concordant group and all others in the nonconcordant group. The primary outcome was in-hospital mortality. Secondary outcomes included intensive care unit (ICU) and hospital length of stay (LOS); vasoactive medications and net volume over 24 h; new mechanical ventilation, new or increased volume removal, and acute kidney injury within 48 h; and shock-free survival at 7 days.</p></div><div><h3>Results</h3><p>One hundred twenty-five patients were included in each group. In-hospital mortality was 34.4% in the concordant group and 44.8% in the nonconcordant group (<em>p</em> = 0.1205). The concordant group had a shorter ICU LOS (7.6 vs. 10.5 days; <em>p</em> = 0.0214) and hospital LOS (12.9 vs. 18.3 days; <em>p</em> = 0.0163), but increased new mechanical ventilation (37.6 vs. 20.8%; <em>p</em> = 0.0052). No differences in other outcomes were observed.</p></div><div><h3>Conclusions</h3><p>Receipt of a 30-mL/kg fluid bolus did not affect outcomes in a cohort of patients with mixed types of HF and sepsis-induced hypoperfusion.</p></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139925184","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Stethoscopes no longer need to touch patients","authors":"W. Frank Peacock MD, FACEP, FACC, FESC","doi":"10.1016/j.jemermed.2024.03.025","DOIUrl":"https://doi.org/10.1016/j.jemermed.2024.03.025","url":null,"abstract":"<div><h3>Background</h3><p>It is clear that, while stethoscopes are commonly used in cancer patients, they are frequently contaminated with pathogens. Even 60 seconds of alcohol swab cleaning doesn't reliably provide sterile contact. Thus ultimately, stethoscopes are potential vectors that transmit pathogens when touching patients. A proposed draft of the new 2024 CDC guidelines mandates that if shared patient-care items are used (e.g., stethoscopes), they must be cleaned and disinfected between patients. This requires that the stethoscope must be cleaned and disinfected between every single patient contact, or a disposable option used. Unfortunately, studies demonstrate that disposable stethoscopes are inferior auscultation tools, vs. the personal stethoscope. Therefore, to be in compliance with 2024 CDC guidelines improvements in personal stethoscope hygiene are required. The DiskCover is a touch free applied single use disposable stethoscope barrier consistent with CDC guidelines. We performed an in vitro investigation the efficacy of the DiskCover (Asepticscope, Inc, San Diego, CA) in providing an aseptic patient auscultation.</p></div><div><h3>Methods</h3><p>This was a prospective, randomized evaluation of the ability of the DiskCover to prevent patient exposure to pathogens found on the stethoscope. Stethoscope diaphragms were inoculated with Candida Albicans (C. Albicans), Clostridioides Difficile (C. Diff), Extended- Spectrum B-Lactamase Producing Escherichia Coli (ESBL), Methicillin Resistant Staphylococcus Aureus (MRSA), Pseudomonas Aeruginosa (P. Aeruginosa), and Vancomycin- Resistant Enterococcus Faecium (VRE), then randomized to either DiskCover placement or control (no DiskCover). Stethoscope's then underwent aerobic or anerobic incubation.</p><p>Diaphragm cultures were obtained at 0.25, 0.5, 2, 4, and 24 hours of incubation, and placed on Blood, Chocolate, and MacConkey agar. Colony formation was subsequently manually counted.</p></div><div><h3>Results</h3><p>Stethoscope diaphragms with a DiskCover were sterile in 100% of cases, while those without Discover's had extensive pathogen contamination. Compared to all controls, for all species of pathogens, all DiskCover contacts were sterile (p&lt;0.05 for all comparisons).</p></div><div><h3>Conclusions</h3><p>DiskCovers provided a sterile point of contact in all instances vs. control, which had large numbers of pathogenetic colonies.</p></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141243277","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Modified PECS II Block for Axillary Hidradenitis Suppurativa","authors":"Michael Shalaby MD ,&nbsp;Raghav Sahni DO ,&nbsp;Daniel Puebla MD ,&nbsp;Stephanie Fernandez MD","doi":"10.1016/j.jemermed.2024.01.007","DOIUrl":"10.1016/j.jemermed.2024.01.007","url":null,"abstract":"<div><h3>Background</h3><p>Hidradenitis suppurativa (HS) is a painful, chronic inflammatory skin condition. Patients experience exacerbations, leading them to present to the emergency department (ED) for incision and drainage. Direct injection of local anesthetic into these lesions is extremely painful and seldom provides adequate anesthesia. A modified method of the PECS II block can provide anesthesia to the skin of the axilla, making management of HS much less painful for the patient. We performed a bilateral modified PECS II block on a patient requiring incision and drainage of HS lesions in both axillae. She subsequently required no local anesthetic for the procedure.</p></div><div><h3>Discussion</h3><p>The second injection of the traditional PECS II block involves the deposition of anesthetic in the fascial plane between the pectoralis minor muscle and the serratus anterior muscles. This injection targets the lateral branch of the intercostal nerves, which provide sensory innervation to the axilla.</p></div><div><h3>Conclusions</h3><p>A modified technique of the PECS II block, in which only the second injection is performed, is a potentially effective method for anesthetizing the axilla of patients with HS prior to incision and drainage.</p></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139579871","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Painless Aortic Dissection Associated with Tyrosine Kinase Inhibitor Therapy","authors":"Huda Fatima MD,&nbsp;Kalen Jacobson MD","doi":"10.1016/j.jemermed.2024.03.029","DOIUrl":"https://doi.org/10.1016/j.jemermed.2024.03.029","url":null,"abstract":"<div><h3>History of presentation</h3><p>A 69-year-old male presented to the ED with a thoraco-abdominal aortic dissection (AD) (DeBakey type IIIB/Stanford classification B) and an intramural thoracic wall hematoma, detected during CT imaging. He arrived with hypertension (BP 160/92, heart rate 81) but was asymptomatic. Physical examination revealed palpable pulses.</p></div><div><h3>Past medical history</h3><p>Stage IV anorectal mucosal melanoma treated with ipilimumab/nivolumab, nivolumab+axitinib, radiation, currently on nivolumab+relatlimab. Prior superior mesenteric and right external artery dissection, right common iliac artery aneurysm, central adrenal insufficiency, hypothyroidism and recent hypertension-related syncopal episodes, leading to discontinuation of Losartan.</p></div><div><h3>Investigations</h3><p>Lab work was normal, EKG showed normal sinus rhythm. Echocardiogram was normal with ejection fraction 60-65%.</p></div><div><h3>Management</h3><p>The patient received IV labetalol and esmolol, following which BP improved. CT indicated chronicity with proximal thrombosis, and surgical intervention was not recommended. Cardiology started coreg 3.125 mg twice daily and a low-dose statin. He was discharged with oral anti-hypertensive meds for outpatient follow-up.</p></div><div><h3>Causes</h3><p>Hypertension, aging, atherosclerosis, connective tissue diseases like Marfan and Ehlers-Danlos syndromes, hereditary factors like Turner syndrome and bicuspid aortic valve, coarctation of the aorta, previous cardiac surgery, smoking, cocaine use, and iatrogenic factors such as VEGFR and TK inhibitors.</p></div><div><h3>Mechanism of action</h3><p>AD results from arterial wall tearing, causing a false lumen due to blood leakage through aortic media [2]. Stress or degeneration factors contribute [2]. Axatinib, a tyrosine kinase inhibitor blocking the TK activities of VEGFR, can lead to hypertension and cardiac dysfunction linked to AD [3]. It's unclear if AD-related hypertension is due to axatinib, suggesting tyrosine kinase inhibitors may directly contribute to AD.</p></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141243280","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Congenital Long QT Syndrome Unmasked by Albuterol in an Adolescent with Asthma","authors":"","doi":"10.1016/j.jemermed.2024.05.011","DOIUrl":"10.1016/j.jemermed.2024.05.011","url":null,"abstract":"<div><h3>Background</h3><p>Patients with congenital long QT syndrome (LQTS) are prone to ventricular dysrhythmia but may be initially asymptomatic with a normal QTc interval on resting electrocardiogram (ECG). Albuterol is listed as a medication that poses a “special risk” to patients with congenital LQTS, but its effects have been rarely described. We present a case of previously unknown, asymptomatic congenital LQTS unmasked by albuterol in an adolescent with asthma.</p></div><div><h3>Case Report</h3><p>A 12-year-old girl with a history of asthma presented to the emergency department (ED) with shortness of breath, wheezing, and tachycardia for 24 h, consistent with acute asthma exacerbation. She received two doses of her home albuterol inhaler 2 h prior to presentation. Initial ECG demonstrated a QTc of 619 ms. Her remaining history, clinical examination, and laboratory workup, including electrolytes, were unremarkable. She was observed with cardiac monitoring before being discharged from the ED in stable condition for next-day outpatient pediatric cardiology follow-up. Resting office ECGs revealed QTcs from 440–470 ms. Exercise stress test revealed QTc prolongation of 520 ms and 500 ms at minute-2 and minute-4 of recovery, respectively. Genetic testing revealed heterozygous pathogenic variants in KCNQ1, consistent with type 1 LQTS.</p></div><div><h3>Why Should an Emergency Physician Be Aware of This?</h3><p>Albuterol may be a cause of marked QTc prolongation in ED patients with underlying congenital LQTS, which can be a diagnostic clue in previously unidentified patients. Extreme QTc prolongation also serves as an indication in the ED for Cardiology consultation, laboratory evaluation for electrolyte imbalances, and observation with cardiac monitoring.</p></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2024-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142140271","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}