Fulminant meningococcal supraglottitis: An emerging infectious syndrome?

We report a case of fulminant supraglottitis with dramatic external cervical swelling due to associated cellulitis. Blood cultures were positive for Neisseria meningitidis. The patient recovered completely after emergency fiberoptic intubation and appropriate antibiotic therapy. We summarize five other cases of meningococcal supraglottitis, all reported since 1995, and discuss possible pathophysiologic mechanisms

Severe Hyperkalemia: Can the Electrocardiogram Risk Stratify for Short-term Adverse Events?

Introduction: The electrocardiogram (ECG) is often used to identify which hyperkalemic patients are atrisk for adverse events. However, there is a paucity of evidence to support this practice. This studyanalyzes the association between specific hyperkalemic ECG abnormalities and the development ofshort-term adverse events in patients with severe hyperkalemia.Methods: We collected records of all adult patients with potassium (K+) ≥6.5 mEq/L in the hospitallaboratory database from August 15, 2010, through January 30, 2015. A chart review identified patientdemographics, concurrent laboratory values, ECG within one hour of K+ measurement, treatments andoccurrence of adverse events within six hours of ECG. We defined adverse events as symptomaticbradycardia, ventricular tachycardia, ventricular fibrillation, cardiopulmonary resuscitation (CPR) and/ordeath. Two emergency physicians blinded to study objective independently examined each ECG forrate, rhythm, peaked T wave, PR interval duration and QRS complex duration. Relative risk wascalculated to determine the association between specific hyperkalemic ECG abnormalities and shorttermadverse events.Results: We included a total of 188 patients with severe hyperkalemia in the final study group. Adverseevents occurred within six hours in 28 patients (15%): symptomatic bradycardia (n=22), death (n=4),ventricular tachycardia (n=2) and CPR (n=2). All adverse events occurred prior to treatment with calciumand all but one occurred prior to K+-lowering intervention. All patients who had a short-term adverse eventhad a preceding ECG that demonstrated at least one hyperkalemic abnormality (100%, 95% confidenceinterval [CI] [85.7-100%]). An increased likelihood of short-term adverse event was found forhyperkalemic patients whose ECG demonstrated QRS prolongation (relative risk [RR] 4.74, 95% CI[2.01-11.15]), bradycardia (HR<50) (RR 12.29, 95%CI [6.69-22.57]), and/or junctional rhythm (RR 7.46,95%CI 5.28-11.13). There was no statistically significant correlation between peaked T waves andshort-term adverse events (RR 0.77, 95% CI [0.35-1.70]).Conclusion: Our findings support the use of the ECG to risk stratify patients with severehyperkalemia for short-term adverse events. [West J Emerg Med. 2017;18(5)963-971.

Severe Hyperkalemia: Can the Electrocardiogram Risk Stratify for Short-term Adverse Events?

Introduction: The electrocardiogram (ECG) is often used to identify which hyperkalemic patients are at risk for adverse events. However, there is a paucity of evidence to support this practice. This study analyzes the association between specific hyperkalemic ECG abnormalities and the development of short-term adverse events in patients with severe hyperkalemia. Methods: We collected records of all adult patients with potassium (K+) ≥6.5 mEq/L in the hospital laboratory database from August 15, 2010, through January 30, 2015. A chart review identified patient demographics, concurrent laboratory values, ECG within one hour of K+ measurement, treatments and occurrence of adverse events within six hours of ECG. We defined adverse events as symptomatic bradycardia, ventricular tachycardia, ventricular fibrillation, cardiopulmonary resuscitation (CPR) and/or death. Two emergency physicians blinded to study objective independently examined each ECG for rate, rhythm, peaked T wave, PR interval duration and QRS complex duration. Relative risk was calculated to determine the association between specific hyperkalemic ECG abnormalities and short-term adverse events. Results: We included a total of 188 patients with severe hyperkalemia in the final study group. Adverse events occurred within six hours in 28 patients (15%): symptomatic bradycardia (n=22), death (n=4), ventricular tachycardia (n=2) and CPR (n=2). All adverse events occurred prior to treatment with calcium and all but one occurred prior to K +-lowering intervention. All patients who had a short-term adverse event had a preceding ECG that demonstrated at least one hyperkalemic abnormality (100%, 95% confidence interval [CI] [85.7–100%]). An increased likelihood of short-term adverse event was found for hyperkalemic patients whose ECG demonstrated QRS prolongation (relative risk [RR] 4.74, 95% CI [2.01–11.15]), bradycardia (HR<50) (RR 12.29, 95%CI [6.69–22.57]), and/or junctional rhythm (RR 7.46, 95%CI 5.28–11.13). There was no statistically significant correlation between peaked T waves and short-term adverse events (RR 0.77, 95% CI [0.35–1.70]). Conclusion: Our findings support the use of the ECG to risk stratify patients with severe hyperkalemia for short-term adverse events