Annals of emergency medicine
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Randomized Controlled Trial Clinical Trial
Intravenous magnesium for acute asthma: failure to decrease emergency treatment duration or need for hospitalization.
To evaluate the efficacy of routine early administration of i.v. magnesium to patients with acute asthma. ⋯ Routine early administration of IV magnesium in acute asthma does not alter treatment outcome.
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The increased prevalence of rodents resistant to warfarin led to the development of the hydroxycoumarin anticoagulant brodifacoum. A 25-year-old man attempted suicide by consuming four boxes of d-CON Mouse-Prufe II; each box contains 42 g of bait that is 0.005% brodifacoum. He presented to a hospital nine days later with syncope, hematochezia, gross hematuria, epistaxis, anemia, and a severe coagulopathy. ⋯ Neurologic status was initially normal, but in the emergency department he suddenly became comatose soon after emesis was induced with syrup of ipecac. Computed tomography of the brain revealed a subarachnoid hemorrhage that led to brain death less than 24 hours later. This case demonstrates the severe and prolonged coagulopathy that can result from ingestion of brodifacoum, a compound that has a toxic potency about 200-fold that of warfarin and a half-life as much as 60 times longer.
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To test the hypothesis that residency-trained emergency physicians who left the practice of emergency medicine do not differ significantly from those who continue to practice. ⋯ Career longevity of residency-trained emergency physicians has been greater than early predictions. Interactions with residents, higher income, satisfaction with training decision, and board certification in emergency medicine are variables associated with a higher retention rate.
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Physicians and the public often assume that herbal preparations are harmless. Aconite is a Chinese herb used as an analgesic by homeopaths; its chief effects are on the cardiovascular and central nervous systems. The first two reported cases of aconite poisoning in Australia are described.
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Randomized Controlled Trial Multicenter Study Comparative Study Clinical Trial
Histamine antagonists in the treatment of acute allergic reactions.
We compared the efficacies of cimetidine (an H2-receptor antagonist) and diphenhydramine (an H1-receptor antagonist) alone and in combination for alleviation of symptoms of acute allergic reactions. STUDY DESIGN AND INTERVENTIONS: In this prospective, randomized, double-blind study, patients and examiners assessed the severity of symptoms and signs of acute allergic reactions using a visual-analog scale before treatment and 30 minutes after treatment with 300 mg IV cimetidine and placebo, 50 mg IV diphenhydramine and placebo, or diphenhydramine plus cimetidine. ⋯ For treatment of pruritus from acute allergic reactions, diphenhydramine is more effective than cimetidine, and the combination offers no additional benefit. For treatment of acute urticaria, the combination of cimetidine and diphenhydramine is more effective than diphenhydramine alone.