GRACE Background
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Diabetic ketoacidosis (DKA) is an endocrine emergency. The standard of care of treating DKA is fluid resuscitation, electrolyte management, and intravenous insulin infusion in the intensive care unit (ICU) setting for close glucose and electrolyte monitoring. Recent research aims at investigating the treatment of DKA with subcutaneous insulin in non-ICU settings.
Prehospital trauma team activation criteria allow for prompt mobilization of personnel and resources. Prehospital hypotension is one of those criteria. Pulse pressure is the difference between systolic and diastolic blood pressure. This is variously defined as a difference of 30-40 mmHg. A narrow pulse pressure occurs due to compensatory increased systemic vascular resistance in the setting of decreased cardiac output.
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Children with knee monoarthritis from Lyme disease and septic arthritis can have similar presentations. The early disseminated stage of Lyme disease, when knee monoarthritis would typically present, occurs 3-5 weeks post tick bite and a history of tick bite may not be present. In addition, synovial fluid cell counts do not distinguish between septic and Lyme arthritis and bacterial cultures and Lyme disease serology may take several days to result.
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Pregnant women have a higher risk of venous thromboembolism (VTE) and an increasing D-Dimer over the course of pregnancy. The majority of clinical guidelines recommend the D-dimer should not be used to assess the risk of VTE in pregnant women. However, CTPE presents a radiation risk to both the mother and fetus. Unfortunately, most VTE studies exclude pregnant women.
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Acute acidemia is common in critically ill adult patients. Use of sodium bicarbonate infusion for the treatment of severe metabolic acidemia is controversial and understudied.
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A strategy of high-sensitivity cardiac troponins over short time intervals for the diagnosis of acute myocardial infarction has been recommended in European cardiology guidelines. It is unclear if the European strategy is generalizable to the US population. A strategy that identifies low risk patients early can lead to limited further diagnostic testing, ED length of stay,
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