The American journal of emergency medicine
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To determine the clinical usefulness of infrared skin temperatures in diagnosing appendicitis, the authors conducted a prospective study of 86 adult and pediatric emergency department (ED) patients presenting during a 4-month study period with acute right lower abdominal pain. Skin temperature readings (FirstTemp digital thermometer, Intelligent Medical Systems, Inc, Carlsbad, CA) were taken from the right lower abdominal quadrant and a corresponding position on the left. An unpaired t test was used to determine if there was a significant difference between the right and left lower quadrants in patients with appendicitis. ⋯ There was no significant skin temperature differential between the lower abdominal quadrants in either patient group (0.0 degree C vs 0.1 degree C; P > .5). Three patients had a skin temperature on the right that was at least 1 degrees C warmer than on the left; none of these patients had appendicitis. The results suggest that infrared thermography is not a sensitive diagnostic test for acute appendicitis in the ED population.
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Sympathomimetic use results in a triad of hypokalemia, hyperglycemia, and elevated white blood cell count. Transient hypokalemia results from activation of the Na+/K+ pump and transport of potassium intracellularly. Increased serum glucose and insulin may also contribute to the intracellular shift of potassium after sympathomimetic use. ⋯ These cases demonstrated that significant depressions in serum potassium can occur after pediatric albuterol overdose. Although transient, the dose-response relationship and duration of effect is unknown. Although significant hypokalemia can occur after ingestion of oral sympathomimetics, replacement should be managed on an individual basis until further studies are completed.
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To evaluate the recently published Utstein algorithm (Ann Emerg Med 1991;20:861), the authors conducted a retrospective review of all advanced life support (ALS) trip sheets and hospital records of patients with prehospital cardiac arrests between January 1988 and December 1989. Telephone follow-up was used to determine 1-year survival rates. Of 713 arrests in the 24-month study period, 601 were of presumed cardiac etiology. ⋯ The Utstein style was found to be a useful algorithmic format for reporting prehospital cardiac arrest data in a manner that should allow direct comparison between emergency medical service (EMS) systems. Existing prehospital record-keeping practices (trip sheets) are easily adapted to this style of data collection, although certain data for the template (eg, resuscitations not attempted and alive at 1-year) are more difficult to ascertain. Additionally, the authors report their own experience during a 2-year period, including data that suggest that the majority of patients with cardiac arrest who survive to hospital discharge are still alive at 1 year.
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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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Ovarian vein thrombosis is a rare occurrence in the postpartum period. Two cases of postpartum ovarian vein thrombosis are presented. ⋯ Early diagnosis is essential for appropriate treatment and prevention of the potential sequelae that can occur. Computerized tomography with contrast is the optimal imaging modality for the diagnosis.