The American journal of emergency medicine
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This report describes two cases of pyogenic sacroiliitis with remarkably similar histories. The initial diagnosis is often overlooked because of its rarity and poorly localized signs and symptoms. Clinical and radiological findings, as well as treatment measures, are discussed. Familiarity with this type of septic arthritis is essential if prompt and appropriate therapy is to be rendered.
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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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This article describes a case of Purtscher's retinopathy, a syndrome believed to be caused by microembolic infarction of the retina, in a 20-year-old man after remote extraocular trauma. The patient jumped from a 20-meter high building. He suffered multiple crush injuries, but a computed tomographic scan of the brain and orbit was normal. ⋯ The ophthalmoscopic picture was characteristic of Purtscher's retinopathy with cotton-wool exudates and retinal hemorrhages localized to the posterior pole. His vision was improved only slightly 6 months later. Although rare, emergency physicians should be familiar with this entity as a cause of diminished vision associated with extraocular trauma.
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Because many communities lack prehospital advanced life support (ALS) services, increasing public access to such care is important. The present study was completed to establish an epidemiological database defining prehospital pharmacotherapeutic interventions by ALS rescue teams, in the hope of developing recommendations for medication administration by non-ALS personnel. Data were collected on 333 patients, including indication for pharmacotherapy, patient age, ambulance field time, route of medication administration, adverse effects of pharmacotherapy, efficacy of pharmacotherapy, additional ALS interventions, and patient medication/past medical history. ⋯ In all, albuterol, D-50, and nitroglycerin accounted for 250 of 395 total medication interventions (63.29%). No inappropriate use, point estimate [(0)/(333) (0.00% to 0.90%)], or unmet need, point estimate [(0)/(3,613) (0.00% to 0.08%)], of care was noted. When faced with communities lacking ALS rescue services, albuterol, D-50, and nitroglycerin are recommended for administration by emergency medical technician-ambulance and intermediate level rescuers, because of the high rate of use, relative ease of administration, and high benefit/low complication rates associated with these medications.