Annals of emergency medicine
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A case of severe methemoglobinemia and hemolytic anemia following ingestion of 5.6 gm of phenazopyridine with suicidal intent by a 16-year-old woman was successfully treated with intravenous methylene blue. Methemoglobinemia was suspected in this patient because of her intense central cyanosis, chocolate-colored blood, and minimal dyspnea. The patient's peripheral blood smear exhibited "bite cells." To the best of our knowledge, this is only the third such case reported in the literature. The pathophysiology, diagnosis, and therapy are reviewed.
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A one year review of resuscitation in an emergency department (ED) was conducted. In the stabilization room (SR) within the ED at Hennepin County Medical Center, 852 cases were treated in the year ending July 31, 1978. ⋯ Of these, 12 deaths were unrelated to central nervous system causes. These had an average ISS of 42.8.
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We present the case of a patient with traumatic ventricular septal defects following blunt chest trauma. The pathophysiology and clinical presentation of the lesion are discussed. Definitive diagnostic procedures should be performed immediately in patients with suggestive findings to establish the diagnosis and to determine the magnitude of the shunt and the presence of pulmonary hypertension.
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Adherence to physician-developed process criteria is critical to the medical and legal acceptance of algorithm-directed nonphysician care of acute non-life-threatening illnesses seen in the emergency department. It is generally assumed that adherence to prescribed medical process criteria results in acceptable patient outcomes. ⋯ Our evaluation indicated that, under ideal circumstances of daily audit and supervisory feedback, a conformance rate of 80% was achieved. This is a 100% improvement over a group in which neither element was operative.