Annals of emergency medicine
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We report six cases of acute carbon monoxide poisoning during pregnancy. All of the women survived with good outcomes, but three cases were associated with fetal mortality. Two fetuses were delivered stillborn within 36 hours of exposure. ⋯ Maternal blood carboxyhemoglobin levels did not correlate with the concurrent severity of symptoms in the woman. Maternal symptoms at the site of exposure seemed to predict the risk of associated morbidity to the fetus. A single maternal carboxyhemoglobin level cannot be used to estimate fetal carboxyhemoglobin if the exposure pattern is not known.
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Case Reports
Successful resuscitation using external cardiac pacing in beta adrenergic antagonist-induced bradyasystolic arrest.
We present a case of attempted suicide by propranolol overdose presenting as convulsions followed by bradyasystolic cardiopulmonary arrest successfully managed by external transcutaneous pacing. Inotropic support and the resulting clinical improvement permitted discontinuation of cardiac pacing after 75 minutes. ⋯ A serum propranolol level of 2,331 ng/mL verified the overdose. This is the first report of successful transcutaneous pacing for beta adrenergic antagonist poisoning.
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We present the cases of two children with lidocaine-induced seizures resulting from the use of oral viscous lidocaine. In the first case, the drug was prescribed for herpetic gingivostomatitis. In the second, a child was treated for teething pain by the mother, who used a relative's medication.
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A 65-year-old woman with a two-day history of progressive back pain presented with acute dyspnea, tachypnea, hypotension, and tachycardia. The patient was being treated for chronic obstructive lung disease and long-standing hypertension. She evidenced unilateral diminished breath sounds and wheezing. ⋯ A hemothorax was confirmed by thoracentesis, and a 7-cm descending thoracic aortic aneurysm was demonstrated by angiography. The patient underwent successful surgical resection and Dacron graft repair of the aneurysm. This case emphasizes the need for maintaining a high index of suspicion for atypical presentations of ruptured thoracic aneurysms and for using diagnostic thoracentesis in pleural effusions of unknown etiology.
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A case of a patient with an alkaline chemical burn to the face from the misuse of the aerosol form of an oven cleaner is presented. The low concentration of sodium hydroxide and lack of early pain delayed the patient's presentation to the emergency department for two hours. After this delay in seeking treatment, continuous irrigation in the ED did little to modify the pH of the patient's injured skin. Thus, she developed a full-thickness alkaline burn that eventually required skin grafting.