Fatal Dysrhythmias Research Articles

Hyperkalemia: Pharmacotherapies and Clinical Considerations.

Hyperkalemia has been defined as a condition where a serum potassium level is >5.5 mmol/l. It is associated with fatal dysrhythmias and muscular dysfunction. Certain medical conditions, such as chronic kidney disease (CKD), diabetes mellitus, and others, can lead to hyperkalemia. Many of the signs of hyperkalemia are nonspecific. A history and physical examination can be beneficial in the diagnosis of the condition. In this regard, certain characteristic electrocardiogram findings are associated with hyperkalemia along with laboratory potassium levels. In acute and potentially lethal conditions, hyperkalemia treatments include glucose and insulin, bicarbonate, calcium gluconate, beta-2 agonists, hyperventilation, and dialysis. There are several drugs, both old and new, that can additionally aid in the reduction of serum potassium levels. The present investigation evaluated some of these different drugs, including sodium polystyrene sulfonate (SPS), sodium zirconium cyclosilicate (SZC), and patiromer. These drugs each have increased selectivity for potassium and work primarily in the gastrointestinal (GI) tract. Each of these medications has unique benefits and contraindications. Clinicians must be aware of these medications when managing patients with hyperkalemia.

Effect of an Educational Program Regarding Cardiac Arrhythmias on Nurses’ Knowledge and Practices in Critical Care Units

Context: Cardiac arrhythmia is a serious condition that can lead to fatal forms of rhythm disturbance. Critical care nurse plays a vital role in arrhythmias management, specializing in symptomatic relief, promoting comfort, and taking crisis management activity in fatal dysrhythmias.
 Aim: To evaluate the effect of an educational program regarding cardiac arrhythmias on nurses' knowledge and practice in critical care units.
 Methods: A quasi-experimental design (pre/test) was applied. This study was carried out at Critical Care Units in Governmental Port-Said general hospitals (Port Said General Hospital, Port-Fouad General Hospital, and Alzhoor Central Hospital) in Port Said Governorate in Egypt. A convenient sample of all available nurses (139) nurses in critical care units was recruited in this study and divided into 116 female and 23 male nurses. The data collection tool encompassed two: A structured interviewing questionnaire with demographic characteristics, a nurses' knowledge questionnaire, and nurses' practice observational checklists.
 Results: The results revealed a nurses' mean age of 25.6 ±5.1; 83.5% were females, and 55.4% had technical nursing institute diplomas. A high statistically significant total knowledge and practice score difference between pre and immediate post-program implementation at p<0.001. Also, among pre and follow-up assessments after educational program application at p<0.001. In addition, there was a statistically significant correlation between total nurses' knowledge score and their total practice score immediately after the educational program (r=0.636, p <0.001). and follow up (r=0.426, p<0.001).
 Conclusion The nursing educational program significantly improved nurses' knowledge and practice regarding cardiac arrhythmias management among nurses working in the critical care units. The study recommended continuous training and educational program for enhancing and apprising the nurses’ knowledge and practice regarding cardiac arrhythmias in the critical care unit.

Ondansetron Safety Regarding Prolong QTc for Children with Head Trauma

BackgroundThere have been recent reports of increased QT interval after head trauma in concussed athletes and adult patients. Ondansetron, which is widely used in treatment of nausea and vomiting symptoms in head injuries, was issued a safety warning from the U.S. Food and Drug Administration regarding QT prolongation and risk of fatal dysrhythmias. ObjectiveThe purpose of this study was to evaluate the safety of ondansetron regarding QT prolongation for patients experiencing nausea or vomiting after head trauma. MethodsPatients aged 1–20 years presenting to a pediatric emergency department with head trauma and who required a dose of ondansetron for nausea or vomiting were enrolled in the study. Patients received a baseline 12-lead electrocardiogram (ECG) prior to administration of either oral or IV ondansetron. A second post-ondansetron 12-lead ECG was performed after administration of ondansetron. All ECGs were reviewed and the QTc calculated manually by a board-certified pediatric cardiologist. ResultsForty-two patients met enrollment criteria. Five patients received IV ondansetron and 37 received oral ondansetron. Mean QTc pre ondansetron was 387.5 ms and mean QTc post ondansetron was 400.9 ms (p = 0.120). We found no statistically significant difference in other ECG parameters pre and post ondansetron. ConclusionsOndansetron is safe in regard to QTc prolongation in patients with head trauma. Based on this research, ondansetron should continue to be used for the treatment of nausea and vomiting in emergency department patients who present with head injury.

Digoxin: Review of Current Laboratory Practice and Considerations

Digoxin is a drug used for its effects on the heart, particularly its effect on rate and strength of contraction. Levels are particularly useful in clinical practice owing to its narrow therapeutic index, with toxicity and therapeutic levels being relatively close. Clinically, digoxin toxicity can be acute or chronic, and can manifest with signs and symptoms related to the gastrointestinal system, nervous system, and cardiovascular system. Given digoxin toxicity can lead to fatal dysrhythmias, accurate and reproducible analysis by the laboratory is essential in the treatment of patients with suspected digoxin toxicity. However, the laboratory workup for digoxin toxicity is not as simple as performing a digoxin level. Other factors such as cross-reacting molecules, the effect of other biochemical findings, and the effect of the digoxin antidote (anti-digoxin antibody fragments) on immunoassay results need to be considered in clinical settings where the results aren’t consistent with clinical findings. The laboratory is ideally placed to help with issues relating from these factors to digoxin level interpretation.

Investigation of the Severity of Increased QT Interval Incidence in Young Patients with COVID-19

Introduction: ECG abnormality is a major problem in COVID-19 patients, especially in the elderly, which can result in fatal dysrhythmias. In this article, QT interval prolongation was investigated in admitted Covid-19 patients of 20-50 years of age without any history of cardiac problems. Methods: This study is a descriptive and analytical study. All consenting patients admitted to the hospital for Covid-19 infection aged 20-50 years old entered the study. Patients with underlying heart and kidney disease, history of taking any medication or cardiac dysrhythmias were excluded. An electrocardiogram was performed on admission and the third day of hospitalization. Results: The average length of hospital stay was 7.9±3.68 days, and all patients had QT interval prolongation after 3 days, but no cardiac dysrhythmia occurred. There was no statistically significant increase in QTc interval for each drug used alone, but the use of various drugs that affect the electrical conduction of the heart and also the presence of underlying inflammation, especially in patient’s heart cells can be the underlying cause of QTc interval prolongation. Many Covid-19 patients have QT interval prolongation. It can be due the infection itself, the drugs used for treatment or viral myocarditis. The results of the present study showed that taking drugs such as kaletra even for 3 days can significantly increase the QTc interval in patients, so care should be taken in the use of these drugs to avoid iatrogenic cardiac disease in patients, although in most cases the increase was mild and didn’t cause mortality in patients.

Effect of Training Program on Nurses knowledge and Practices Regarding Cardiac Arrhythmias

Background: The role of critical care nurse in arrhythmias management specializes in symptomatic relief, promotion of comfort and taking crisis activity in fatal dysrhythmias. Aim: The aim of the study was to evaluate the effect of training program on nurses' knowledge and practice regarding cardiac arrhythmias in critical care units at Zagazig University Hospitals, Egypt. Subjects and Methods: Research design: A quazi experimental design was utilized to achieve the aim of this study. Setting: The study was conducted at Critical Care Units at Zagazig University Hospitals. Sample: A convenient sample of 30 nurses was included in this study. Tools of data collection: Questionnaire and observational checklists regarding cardiac arrhythmias were used. Data were collected over a period of nine months. Results: There was a significant improvement in nurses’ knowledge and practice in post and follow up phase of training program compared to pre program. Conclusion: the training program had an obvious effect on improving nurses' knowledge which reflected then on improving their skills. Recommendations: It was recommended periodic evaluation of nurses' knowledge and skills concerning any emergency situation in the critical care units.

Chloroquine Ingestion to Prevent SARS-CoV-2 Infection: A Report of Two Cases.

IntroductionAmid the global pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), chloroquine and hydroxychloroquine were being studied as agents to prevent and treat coronavirus disease 2019. Information about these agents and their effects circulated throughout the general public media, raising the concern for self-directed consumption of both pharmaceutical and non-pharmaceutical products.Case ReportWe present two cases of chloroquine toxicity that occurred after ingestion of an aquarium disinfectant that contained chloroquine phosphate in a misguided attempt to prevent infection by SARS-CoV-2. One patient had repeated emesis and survived, while the other was unable to vomit, despite attempts, and suffered fatal cardiac dysrhythmias.ConclusionThese cases illustrate the spectrum of toxicity, varied presentations, and importance of early recognition and management of chloroquine poisoning. In addition, we can see the importance of sound medical guidance in an era of social confusion compounded by the extremes of public and social media.

An Evidence-Based Narrative Review of the Emergency Department Management of Acute Hyperkalemia

The normal range for potassium is within narrow limits. Hyperkalemia is an electrolyte disorder that frequently affects patients in the emergency department (ED), and can result in significant morbidity and mortality if not identified and treated rapidly. This article provides an evidence-based narrative review of the management of hyperkalemia, with focused updates for the emergency clinician. We searched in MEDLINE, EMBASE, Web of Science, and Scopus databases for articles in English published in peer-reviewed journals and indexed up until May 2020. We used multiple search terms, including hyperkalemia, potassium, acute hyperkalemia, emergency department, dyskalemia, potassium disorders, kidney disease, epidemiology, electrolyte disturbance, severe hyperkalemia, and emergency management. In the ED, interventions aimed to protect patients from the immediate dangers of elevated serum potassium are divided into the following: stabilizing cardiac membrane potentials, reducing serum potassium levels through shift from the extracellular fluid to intracellular fluid, and elimination of potassium through excretion via urinary or fecal excretion. Calcium is widely recommended to stabilize the myocardial cell membrane, but additional research is necessary to establish criteria for use, dosages, and preferred solutions. Redistribution of potassium ions from the bloodstream into the cells is based on intravenous insulin or nebulized β2-agonists. Hyperkalemia is a frequent electrolyte disorder in the ED. Because of the risk of fatal dysrhythmia due to cardiac membrane instability, hyperkalemia is a medical emergency. There is a lack of scientific evidence on the optimal management of hyperkalemia and more research is needed to establish optimal strategies to manage acute hyperkalemia in the emergency department.

Pilot Study to investigate Home Potassium testing in Heart Failure

Background and hypothesis: Heart failure (HF) is one of the leading causes of death in the United States. Normal potassium range is 3.5 to 5 mEq/L. Low potassium level is associated with fatal dysrhythmia, and elevated potassium levels result in slow cardiac rhythms and asystole. Current venipuncture methods used for potassium testing are complicated with hemolysis, which create false potassium results. Our study objective is assessing the effectiveness of an at home device that would enable HF patients to test potassium levels frequently to avoid any complications as it relates to dyskalemia. We hypothesize that by utilizing a home testing solution, patients can develop a home HF management strategy to improve health outcomes. 
 
 Experimental Design or Project Methods: Patients diagnosed with HF will be recruited from Parkview Physicians Group – Cardiology. A venipuncture and a finger stick sample will be collected simultaneously, and their serum potassium levels will be analyzed. Venipuncture blood will be analyzed by ion-selective electrode (ISE) and flame photometry analyses. Finger stick blood will be analyzed by a novel Blaire Biomedical device. Surveys about the device will be given to both patients and clinicians. Linear regressions comparing the Blaire Biomedical results to both the ISE and flame photometry results will be created. 
 
 Results: The r-values for the regressions will be analyzed. An r-value close to 1 would indicate that the results are directly correlated and clinically equivalent. Results of the surveys will be used to gauge interest in the device. 
 
 Conclusion and Potential Impact: This study will establish a more efficient way for HF patients to measure potassium levels and ensure levels stay in the range of 3.5 to 5 mEq/L. This device will assist in reducing potassium imbalance complications, which will translate to a decrease in mortality in HF patients as it relates to dyskalemia.

QTc interval prolongation associated with inpatient azithromycin therapy for pneumonia.

In 2013, the US Food and Drug Administration issued a warning regarding the use of azithromycin and the risk of fatal dysrhythmias after a 14-year retrospective analysis showed increased risk of cardiovascular-related death in patients who had taken a 5-day course of azithromycin compared with those who took amoxicillin, ciprofloxacin, or no antibiotics. At the authors' institution, pneumonia is the most common diagnosis for which azithromycin is used as a treatment for patients who are hospitalized. To compare corrected QT (QTc) interval measurements on electrocardiogram (ECG) before and after inpatient azithromycin treatment for pneumonia. The authors retrospectively reviewed the medical records of 642 patients age 18 years and older who were diagnosed with pneumonia and treated with azithromycin at an academic teaching hospital between January 1, 2017 and December 31, 2017. Patients who had an ECG performed both before and after azithromycin treatment were included and divided into 2 groups: those who had 1 dose of azithromycin (Group 1) and those who had 2 doses (Group 2). Patients were excluded if they had a baseline QTc interval on initial ECG greater than or equal to 500ms, any signs of ischemia or myocardial infarction, any initial dysrhythmia or underlying ECG abnormalities, or absence of pre- and post-ECG results. Outcomes measures included a comparison of QTc intervals on ECG before and after azithromycin, and an analysis of the percentage of patients with a QTc interval measurement greater than 500ms on ECG after azithromycin treatment. Our primary outcome measurement was the QTc interval measurement on ECG before and after azithromycin in patients treated with azithromycin for community acquired pneumonia. Our secondary outcome measurement was the percentage of patients with a QTc interval measurement of greater than 500ms on ECG after azithromycin treatment. A Wilcoxon signed-rank test was used to evaluate repeated QTc measures of our primary outcome in Group 1 and Group 2. Our secondary outcome was reported as a percentage of total patients with a QTc interval of greater than 500ms after azithromycin doses on ECG. Of 642 patients, 142 had available pre- and post-EGC results available; 100 were included in Group 1 (1 dose) and 42 in Group 2 (2 doses). Mean QTc interval differences after 1 dose of azithromycin exhibited an increase compared to baseline values (424 vs 477ms). A Wilcoxon signed-rank test indicated a significant QTc prolongation after 1 dose of azithromycin (mean rank, 43.76; Z=-4.921; P<.001). QTc interval differences after 2 doses of azithromycin did not reach statistical significance when compared to baseline values (422 vs 444ms). A total of 10 patients (10%) in Group 1 and 4 patients (9.5%) in Group 2 had a QTc interval >500ms after azithromycin. There were no documented dysrhythmias during hospitalization in this study period. QTc interval increases were observed during inpatient azithromycin therapy for pneumonia, but were not found to be associated with cardiac dysrhythmias during hospitalization.

Suicide from a Cerbera odollam kernel

We report the case of a 22 year-old female patient who died 24 hours after consuming 2 seeds of the mangrove plant Cerbera odollam, locally known as the Pong pong tree from fatal dysrhythmia. This fruit is responsible for a lot of suicidal deaths in Kerala, India but rarely in Singapore1. These seeds contain active cardiac glycosides similar to digoxin which can result in fatal dysrhythmias and hyperkalaemia.

Abstract P391: The Effects of Obstructive Sleep Apnea on Cardiac Arrhythmia Risk

Background: Over 20 million people in the United States suffer from Obstructive Sleep Apnea (OSA). Compared to the general population, OSA patients are 2.6 times more likely to experience sudden cardiac death (SCD), and it is suspected that this is due, in part, to QT prolongation leading to fatal dysrhythmias. OSA events have previously been shown to cause prolonged QT intervals compared to the post-apnea hyperventilation period, and studies have also observed increased QT dispersion in patients without cardiac disease. However, those with cardiac disease may be at the greatest risk for SCD, and it is not known what role QT prolongation plays and what factors influence these responses. Thus, the purpose of this study is to evaluate the factors that affect QT interval during periods of sleep apnea including OSA severity, time of night, and quantity of obstructive apneic events during sleep. Methods: We determined QTc intervals from the electrocardiograms of 36 patients undergoing polysomnography for diagnosis of OSA. Patients that were selected had an apnea hypopnea index &gt;20/Hr and had no prior myocardial infarction or heart failure. Each patient’s ECG during their sleep study was analyzed to assess QT interval throughout the night. Baseline QT intervals were compared to QT intervals during obstructive apneas during the first 2 hours of sleep (Early) and last 2 hours of sleep (Late). In addition, apneas &gt;40 seconds were analyzed in 11 patients for changes in QTc as the apnea progressed. Statistical comparisons were made with paired t tests and a one-way ANOVA analysis with repeated measures. Results: Early analyses of data showed QTc intervals in Early and Late apneas were significantly prolonged compared to awake baseline (p=0.04 and p=0.006 respectively). For patients with apneas &gt;40 seconds, significant differences in QTc interval were observed at increasing time points during the apnea compared to the QTc immediately preceding the apnea (p&lt;0.001). Furthermore, patients with longer apneas tend to have longer baseline QTc (p=0.07). Conclusions: Sleep apneic events are associated with periods of mild QTc prolongation despite some cardiac cycle shortening. The prolongation tends to become enhanced later in the night, implying that there is a cumulative effect of numerous prior apneas. Furthermore, prolongation tends to increase as the apnea duration progresses. Early data analyses also suggest that baseline QTc tends to be longer in patients who have more severe/longer apneic events throughout the night. Future studies will focus on QTc changes in OSA patients with prior heart disease, as these are the patients at greatest risk for serious arrhythmias during the night.

The impact of debriefing modalities on nurse practitioner students’ knowledge and leadership skills in managing fatal dysrhythmias: A pilot study

Acute care nurse practitioners (ACNPs) require special training and educational preparation to meet their role expectations. Using high fidelity simulation with debriefing modalities is considered one of the innovative learning strategies in graduate nursing. No studies have investigated debriefing modalities in nurse practitioner programs specially ACNPs leadership skills. The purpose of this study was to examine the difference in students' knowledge, code team leader skills and self-efficacy using two debriefing modalities. A two group, pretest-posttest quasi-experimental design was used. Students were divided into video-assisted debriefing group vs. verbal debriefing following a simulation scenario of managing emergency codes. There were no significant differences between the two groups in knowledge acquisition/retention, leadership skills, and self-efficacy, but there was a significant difference in self-efficacy in both groups between two-time points. There was a general improvement in teams' performance. Students preferred verbal debriefing over video-assisted debriefing. The debriefing session plays an important role in graduate nursing education. Acute care nurse practitioners are lacking a formal leadership training to meet their advanced role. Nurse Educators, and simulation/debriefing leaders may benefit from our study results to develop a structured, formal curriculum and educational instruction focusing on acute care nurse practitioners’ role change especially leading a resuscitation team.

Extracorporeal Membrane Oxygenation for Hypokalemia and Refractory Ventricular Fibrillation Associated with Caffeine Intoxication.

Caffeine has been reported as a cause of cardiac arrest after massive overdose. Here, we report the case of a patient with caffeine intoxication, which can cause fatal dysrhythmias and severe hypokalemia. They were successfully treated with extracorporeal membrane oxygenation (ECMO). A 43-year-old woman with a history of bipolar disorder presented to the emergency department after suicidal drug ingestion (caffeine and amitriptyline). Immediately after arrival, she experienced multiple episodes of ventricular fibrillation with severe hypokalemia requiring cardiopulmonary resuscitation and medical therapy. However, conventional treatment was not successful. We instituted ECMO early during resuscitation because prolonged hypokalemia refractory to aggressive potassium replacement precluded the use of antidysrhythmic medications for refractory circulatory compromise with ventricular fibrillation. The use of ECMO provided time to correct hypokalemia (19.3g potassium) and reduce the caffeine level with hemodialysis. Although she had sustained cardiac arrest, she recovered fully and was discharged home. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Our case indicates the potential effectiveness of ECMO in severely poisoned patients with fatal dysrhythmias. ECMO could provide time for removal of toxic drugs and correction of electrolyte abnormalities.

Bathroom Entrapment Leading to Cardiac Arrest From Crush Syndrome

Crush injuries have the potential to cause life-threatening systemic effects such as hyperkalemia, dysrhythmias, acute kidney injury, and renal failure. Systemic involvement is known as crush syndrome (CS) and results from tissue ischemia and muscle necrosis. This is a report of a 76-year-old female who developed a fatal dysrhythmia following release of her extremity from prolonged entrapment in bathroom safety equipment. Hyperkalemia should be presumed in any crush injury and be treated empirically and aggressively. Although tourniquet application prior to extrication is not widely recommended to prevent CS, it should be considered in prolonged extremity entrapment.

Corrected QT Interval Prolongation in Hospitalized Pediatric Patients Receiving Methadone.

Methadone is often used in pediatric patients to prevent or treat opioid withdrawal after prolonged sedation. Prolonged corrected QT interval is an important adverse effect of methadone because it can progress to torsades de pointes, a potentially fatal dysrhythmia. The prevalence of corrected QT interval prolongation and contributing risk factors are not well defined in hospitalized pediatric patients receiving methadone. The study purpose was to identify the frequency and risk factors of corrected QT interval prolongation in hospitalized pediatric patients receiving methadone. Retrospective cohort study. Tertiary academic pediatric hospital, University of California Davis Children's Hospital, Sacramento, CA. Cohort of 89 pediatric patients (birth to 18 yr) who received at least one dose of methadone while hospitalized. Retrospective data over 7.5 years were obtained from the electronic health record. From the cohort, 45 patients (50.6%) had documented corrected QT interval prolongation (≥ 450 ms) during the study period. No episodes of torsades de pointes were identified. In univariate analyses, higher maximum methadone doses were associated with a prolonged corrected QT interval (0.98 vs 0.59 mg/kg/d; odds ratio, 2.56; 1.15-5.70). Corrected QT interval prolongation occurred more frequently in patients with cardiac disease (63% vs 41%; p = 0.10). No factors were statistically significant in the multivariate analysis. In hospitalized pediatric patients receiving methadone, corrected QT interval prolongation was common, but no episodes of torsades de pointes were documented. Risk factors that have been identified in adults were not associated with prolongation in our study population.

Effect of intravenous ondansetron on QTc interval in children with gastroenteritis

BackgroundThe potential for ondansetron to cause QT prolongation and fatal dysrhythmia is well-reported, including a 2011 FDA report on the topic. Few clinical trials evaluating this phenomenon in the ED setting exist, and only one is pediatric. ObjectiveWe have sought to determine the effect of a standardized dose of intravenous ondansetron on the QTc duration of children under 14years of age treated for gastroenteritis-associated vomiting in a pediatric ED. This study is modeled closely after an FDA “thorough QT study”. MethodsEGCs were obtained before and 15, 30, 45, and 60min after a 0.15mg/kg IV dose of ondansetron given for gastroenteritis-associated vomiting. QT intervals were measured manually with digital calipers, and the QTc interval calculated both by Bazett's (QTcB) and Fridericia's (QTcF) correction. A paired t-test comparing QTc was conducted, and frequency of categorical outcomes of prolongation>30msec, >60 msec, and absolute prolongation >450 msec, >480 msec, and >500msec were evaluated. ResultsIn a 4-month period, 134 patients were included in the study, 46% were male. The average QTc prior to ondansetron administration was: QTcB 415 msec (95% CI 343–565) and QTcF 373 (95% CI 304–499). The mean difference in QTc after ondansetron was 0.4msec for QTcB (95% CI −35–45msec) and 0.1msec for QTcF (95% CI −40–18msec). ConclusionIn these children, 0.15mg/kg of intravenous ondansetron did not cause prolongation of QTcB or QTcF measured 15min after administration, nor at later times.

Tetraparesis and Failure of Pacemaker Capture Induced by Severe Hyperkalemia: Case Report and Systematic Review of Available Literature

BackgroundIn severe hyperkalemia, neurologic symptoms are described more rarely than cardiac manifestations. We report a clinical case; present a systematic review of available literature on secondary hyperkalemic paralysis (SHP); and also discuss pathogenesis, clinical effects, and therapeutic options. Case ReportA 75-year-old woman presented to the emergency department complaining of tetraparesis. Her serum potassium level was 11.4 mEq/L. Electrocardiogram (ECG) showed a pacemaker (PMK)-induced rhythm, with loss of atrial capture and wide QRS complexes. After emergency treatment to restore cell membrane potential threshold and lower serum potassium, neurologic and ECG signs completely disappeared. An acute myocardial infarction subsequently occurred, possibly linked to tachycardia induced by salbutamol therapy. We reviewed 99 articles (119 patients). Mean serum potassium was 8.8 mEq/L. In most cases, ECG showed the presence of tall T waves; loss of PMK atrial capture was documented in 5 patients. In 94 patients, flaccid paralysis was described and in 25, severe muscular weakness; in 65 patients, these findings were associated with other symptoms. Concurrent renal failure was often documented. The most frequent treatments were dialysis and infusion of insulin and glucose. Eighty-seven percent of patients had complete resolution of symptoms. Why Should an Emergency Physician Be Aware of This?Severe hyperkalemia is always a life-threatening medical emergency, as it can precipitate fatal dysrhythmias and paralysis. SHP should be considered in the differential diagnosis of neurologic signs and symptoms of uncertain etiology, especially in a subject with kidney failure or who is taking medications that may worsen renal function. The presence of a PMK does not necessarily impede hyperkalemic cardiac toxicity.

Transcardiac Conducted Electrical Weapon (TASER) Probe Deployments: Incidence and Outcomes

BackgroundTASER (TASER International, Scottsdale, AZ) conducted electrical weapons (CEWs) are commonly used by law enforcement officers. Although animal studies have suggested that transcardiac CEW discharges may produce direct cardiac effects, this has not been demonstrated in human studies. ObjectivesThis study sought to determine the incidence and outcomes of transcardiac CEW probe impact locations in a large series of actual CEW deployments. MethodsA multi-center database of consecutive CEW uses by law enforcement officers was retrospectively reviewed. Case report forms were independently reviewed by three investigators to identify cases with paired probe configurations potentially producing a transcardiac discharge vector. Descriptive analysis was performed and inter-rater reliability was assessed. ResultsAmong 1201 total CEW uses, 813 included probe deployments and 178 cases had paired anterior probe impacts potentially capable of producing a transcardiac discharge vector. This represents 14.8% of all CEW uses (95% confidence interval [CI] 12.9–16.9%) and 21.9% of CEW uses in probe mode (95% CI 19.1–24.9%). Inter-rater agreement was very good, with kappa = 0.82. There were no immediate deaths in any cases (97.5% CI 0.0–0.3%) to suggest a cardiac dysrhythmia, including those with transcardiac discharge vector. ConclusionCEW deployments with probe impact configurations capable of producing a transcardiac discharge occur in a minority of cases in field use conditions. None of these cases, transcardiac or otherwise, produced immediately fatal dysrhythmias. These data support the overall safety of CEWs and provide a benchmark estimate of the likelihood of transcardiac discharge vectors occurring in field use of CEWs.

Fatal Dysrhythmia Following Initiation of Lansoprazole During a Long-Term Course of Voriconazole

Fatal Dysrhythmia Following Initiation of Lansoprazole During a Long-Term Course of Voriconazole