The American journal of emergency medicine
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Clinical Trial
Racemic epinephrine in the treatment of laryngotracheitis: can we identify children for outpatient therapy?
The purpose of this study was to identify a cohort of children with laryngotracheitis (croup) who may be safely discharged from the emergency department (ED) after treatment with nebulized racemic epinephrine (RE), corticosteroids, and prolonged observation. Consecutive children (younger than 13 years of age) presenting to the ED with the diagnosis of laryngotracheitis were evaluated prospectively according to a croup scoring system. Sixty-one patients (4 to 108 months of age) with persistent inspiratory stridor at rest after 20 minutes of mist therapy who received nebulized RE (0.05) mL/kg of a 2.25% solution) and intramuscular dexamethasone (0.6 mg/kg) were enrolled in the study. ⋯ If a child had persistent resting stridor or a croup score greater than 2 at that time, hospitalization was inevitable. The 30 patients admitted to the hospital were younger (19.1 v 27.8 months) and had higher pretreatment croup scores (5.7 v 4.1). This was the first prospective study to identify a subset of children who have received RE to be safely discharged home after observation in the ED.
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Review Case Reports
Torsades de pointes induced by erythromycin and terfenadine.
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Case Reports
The serotonin syndrome associated with paroxetine, an over-the-counter cold remedy, and vascular disease.
There is a new, potentially fatal disorder that is infrequently reported. The apparent rareness may be because of a lack of recognition of the syndrome or its predisposing factors. Fluoxetine (Prozac, Dista Products Co, Division of Eli Lilly Co, Indianapolis, IN), sertraline (Zoloft, Roerig Division, Pfizer Inc, New York, NY), and paroxetine (Paxil, SmithKline Beecham Pharmaceuticals, Philadelphia, PA) belong to a new class of antidepressant medication: the serotonin reuptake-inhibitors (SRIs). ⋯ There have been no prior reports of this interaction. Discontinuation of the offending agents, sedation, and supportive care are the mainstays of treatment. The interactions of serotonin with platelets and vascular endothelium are also discussed.
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Pulmonary thromboembolism (PTE) is a disease whose diagnosis in the emergency department constitutes a challenge to the clinician. Perfusion lung scans have been important in helping in this context, mainly because of the fact that a normal perfusion lung scan rules out the presence of a clinically significant PTE. Nevertheless, false-positive results are sometimes observed, causing a diagnostic dilemma. ⋯ In such patients, some characteristics of the scintigraphic imaging could guide the diagnosis toward a nonembolic origin of the perfusion defect. A case of small-cell carcinoma of the lung involving the left pulmonary artery whose clinical presentation suggested considering the possibility of PTE is reported. The so-called "stripe sign" is reviewed, and certain clues for the differential diagnosis of a massive and one-sided perfusion defect are discussed.