Measurement of Procalcitonin as an Indicator of Severity in Patients With Chronic Obstructive Pulmonary Disease Admitted With Respiratory Illness.

Introduction Exacerbations of chronic obstructive pulmonary disease (COPD) are a frequent reason for hospital admission and a major cause of morbidity and mortality. A useful biomarker or indicator of disease severity at the time of presentation could help guide treatment and identify those with poor prognosis who need early aggressive intervention. We hypothesized that patients who present to the hospital with COPD exacerbations who are found to have elevated procalcitonin (PCT) levels will have worse outcomes such as longer admissions, increased intensive care unit (ICU) utilization, and more frequent readmissions than those with normal levels, regardless of presence or absence of infiltrate on initial chest X-ray (CXR).

Severe hyponatremia associated with thiazide diuretic use.

Background: Thiazide diuretics are commonly used as first-line antihypertensive agents. Hyponatremia is a reported, though uncommon, complication of thiazide use. Although the exact mechanism of thiazide-induced hyponatremia (TIH) is unclear, it can be a significant cause of morbidity and mortality.

Atrial tachycardia mimicking atrioventricular nodal reentry tachycardia.

Background: The term supraventricular tachycardia (SVT) is used to describe tachydysrhythmias that require atrial or atrioventricular nodal tissue for their initiation and maintenance. SVT can be used to describe atrioventricular nodal reentry tachycardia, atrioventricular reentry tachycardia, and atrial tachycardia (AT). AT is the least common of these SVT subtypes, accounting for only 10% of cases.

Elevation of troponin I in athletes: a case report in a marathon runner.

The case of a 24-year-old athlete who presented with a syncopal episode after having run 25 miles in a marathon is reported. The patient was subsequently found to have significant elevations of troponin I, which remained detectable for 3 days. The patient remained asymptomatic during his 8-day hospitalization without other evidence of cardiac ischemia: studies included echocardiography and multiple gated acquisition (MUGA) scan.

Locked anterior-inferior shoulder subluxation presenting as luxatio erecta.

Shoulder subluxation may present as a complication of either traumatic injury to a joint, repetitive mictrotrauma, or atraumatic joint laxity. The case of a middle-aged man who presented with a confusing clinical picture similar to inferior shoulder dislocation, luxatio erecta, with a radiographic diagnosis of anterior-inferior shoulder subluxation is discussed. An understanding of the differential diagnosis of shoulder dislocation and subluxation and the management of atypical presentations is critical to the emergency physician.