The American journal of emergency medicine
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Case Reports
Severe low back pain secondary to acute interstitial nephritis following administration of ranitidine.
Acute interstitial nephritis is a disease characterized by renal inflammation and is thought to be secondary to a hypersensitivity reaction. Although the causes of acute interstitial nephritis are numerous, adverse reactions to many common drugs, particularly antibiotics and nonsteroidal anti-inflammatory agents, are important etiological factors. ⋯ A case of acute, severe, low-back pain and rash in a healthy woman found to be secondary to acute interstitial nephritis is reported. The etiology of acute interstitial nephritis in this patient's case is suspected to be ranitidine (Zantac; Glaxo Pharmaceuticals, Research Triangle Park, NC), which has not been previously associated with this syndrome.
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A case of atypical or complicated migraine is presented with signs and symptoms of meningeal irritation, projectile emesis NS obtundation, and unresponsiveness. The patient is a 19-year-old diabetic on insulin who had a mild episode of upper respiratory tract symptoms with severe headache and was found unresponsive and brought to the emergency department. After a work-up for meningitis was negative (as well as computerized tomography and magnetic resonance imaging) he recovered totally in 3 days with no residual signs or symptoms and was discharged from the hospital.
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In 1989, Champion et al recommended revising the Trauma Score to exclude capillary refill because it is "difficult to assess at night. . . ." However, a literature search produced no studies evaluating the effect of lighting conditions on the assessment of capillary refill. This study was undertaken to determine if any such effect exists. ⋯ In daylight conditions (partly cloudy day, lux meter = 15 to 16), capillary refill was reported as normal in 94.2% of the participants, delayed in 1.9% of the participants, and undetected in 3.9% of the participants. In dark conditions (moonlight or street lamp, lux meter = 4 to 6), capillary refill was reported as normal in 31.7% of the participants, delayed in 1.6% of the participants, and undetected in 66.7% of the participants. chi 2 analysis demonstrated a statistically significant difference between capillary refill assessment in light versus dark environments (P < .001).
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Little data exist concerning the actual onset time (time zero) in sudden death (SD) and acute myocardial infarction (AMI). Most studies have focused on describing the warning arrhythmias that occur before SD and AMI and have relied on retrospective analyses of fortuitous data obtained from patients who experience these adverse outcomes while undergoing routine ambulatory holter monitoring. ⋯ Analyses of the serial 12-lead electrocardiographs showed extensive transient silent ST-segment elevations and depressions preceding cardiac arrest and AMI and provided insight in the pathogenesis of SD and AMI. Continuous 12-lead ECG monitoring can identify patients at high risk for SD and AMI and allow physicians to intervene before the development of life-threatening conditions.
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The objective of this study was to test the hypothesis that after hemorrhagic hypotension, reinfusion of the shed blood with threefold that volume of lactated Ringer's (LR) solution will significantly increase lung water and venous admixture and hence decrease systemic arterial oxygen saturation. A prospective, randomized, fixed-volume hemorrhage laboratory study was performed at the Oklahoma University Health Sciences Center on 18 anesthetized mongrel dogs. ⋯ However, lung water, venous admixture, and systemic arterial PO2 were similar between groups. In this fixed-volume hemorrhage model, hemodiluting the reinfused shed blood with threefold the volume of LR did not significantly influence lung water, venous admixture, or systemic arterial oxygen saturation.