A 39-year-old Asian male presented to the ED complaining of weakness that began gradually after eating a large meal. His legs were affected more than his arms and, over 3 to 4 hours, the weakness progressed to the point that he could no longer bear weight. He also noted palpitations and tingling in both legs, but there was no headache, dizziness, diplopia, dysphagia, dysarthria or shortness of breath. On further questioning, he reported a tremor, heat intolerance, diaphoresis and palpitations, and a loss of 20 pounds over a 2-month period.

The correct diagnosis is D. In this case, a routine electrolyte screen revealed a serum potassium of 1.7 mmol/L (normal = 3.5−5.0) and a serum phosphate of 0.39 mmol/L (0.80–1.60). Calcium, magnesium, creatine kinase and ESR (erythrocyte sedimentation rate) were normal.

Jusqu’à quel point la loi s’est-elle immiscée dans la pratique médicale? Les tribunaux peuvent-ils nous «obliger» à réanimer des patients lorsque nous jugeons l’intervention inutile? M. A.S., un homme âgé de 79 ans arrive difficilement à parler et à avaler à la suite de plusieurs AVC. Il a subi une trachéostomie et il ne peut exprimer ses propres souhaits. En 1998, lorsqu’il fut admis dans un hôpital de réadaptation, ses médecins rédigèrent un ordre de ne pas réanimer. Par la suite, comme l’ont rapporté les journaux, l’épouse de M. A.S. obtint une injonction «obligeant» le personnel de l’hôpital à administrer la réanimation dans le cas d’un arrêt cardiaque. Cette cause bien connue est présentement en litige devant les tribunaux du Manitoba. Qui a le dernier mot lorsque les médecins et les patients sont en désaccord? Quelles leçons doivent en tirer les médecins d’urgence? Le présent article discute des questions éthiques entourant la réanimation.

Gastric volvulus is a rare but potentially life-threatening cause of upper gastrointestinal obstruction. Emergency physicians must maintain a high index of suspicion in patients who present with signs and symptoms suggesting foregut occlusion. We report an illustrative case and review the pathogenesis, classification, diagnosis and treatment of this rare entity.

Prior to the 1998 Vancouver Asian Pacific Economic Summit, emergency physicians were briefed on the possibility of terrorist-related biological or chemical weapons incidents. As part of a training exercise, the “victim” of a chemical weapon attack was brought to our ED. Because of confusion and ignorance, the “victim,” the physician, several members of the ED staff, and a number of other patients also became “casualties.”