Pharmacotherapy
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Randomized Controlled Trial Clinical Trial
Evaluation of electrocardiographic and hemodynamic effects of caffeine with acute dosing in healthy volunteers.
To evaluate the effects of moderate, single-dose caffeine consumption on electrocardiographic variables: PR, QRS, QT, QTc, and RR intervals, and QT and QTc interval dispersion. Effects of caffeine on blood pressure and heart rate also were evaluated. ⋯ Moderate caffeine consumption by healthy young adults does not acutely affect PR, QRS, QT, QTc, and RR intervals, or QT and QTc interval dispersion. Caffeine-naive subjects experienced persistent elevations in SBP and DBP 3 hours after caffeine ingestion, indicating that longer caffeine abstinence than that which is recommended is necessary for blood pressure determination in the clinical setting.
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To determine the validity and reliability of the Sedation-Agitation scale (SAS) when administered by intensive care unit (ICU) nurses with no experience in its use. ⋯ The SAS is reliable when administered by staff nurses with no experience with it. Due to the paucity of observations of agitated patients, we were unable to determine its validity for assessing agitation.
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A 54-year-old patient, admitted to the intensive care unit with a diagnosis of severe pancreatitis, developed circulatory shock that failed to respond to standard vasopressor treatment: epinephrine and norepinephrine. Addition of vasopressin helped reduce standard catecholamine need while maintaining adequate arterial blood pressure. Vasopressin appears to be a promising agent for maintaining arterial pressure during septic shock or systemic inflammatory response syndrome, but due to limited data and potential side effects, its use as first-line treatment for these indications is not recommended.
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Anticonvulsant hypersensitivity syndrome (AHS) is a rare but potentially life-threatening reaction that occurs in response to common anticonvulsants in predisposed individuals. It is often characterized by fever, rash, lymphadenopathy, hepatitis, and laboratory abnormalities. ⋯ We report a case of AHS in a patient whose clinical features changed significantly when switching from phenytoin to carbamazepine. Physicians and pharmacists must become aware of the extreme variability in AHS manifestation so that the offending anticonvulsant regimen can be discontinued in a timely manner.