The American journal of emergency medicine
-
Multicenter Study Comparative Study Clinical Trial Controlled Clinical Trial
Concomitant administration of antiemetics is not necessary with intramuscular dihydroergotamine.
The influence of concomitant administration of an antiemetic agent on the course of nausea was assessed in a field trial of intramuscular dihydroergotamine for the treatment of acute migraine. Of 311 migraine patients enrolled onto the study, 62% (191 of 311) experienced nausea at the outset; 38% (119 of 311) did not. Of those with nausea at the outset, 54% (103 of 191) received an antiemetic. ⋯ At the 30-minute point, 35% (61 of 173) of patients who received dihydroergotamine alone still experienced nausea versus 47% (62 of 133) of patients who received an antiemetic. At the 60-minute point, only 24% (42 of 174) of those given dihydroergotamine alone had nausea, compared with 38% (50 of 132) given concomitant antiemetic. Ongoing nausea seems to be a manifestation of the migraine process rather than an adverse effect associated with intramuscular dihydroergotamine.(ABSTRACT TRUNCATED AT 250 WORDS)
-
There is little experience with overdose of the relatively new antidepressant bupropion. The case of an 18-year-old healthy adult female patient after an intentional ingestion of 9 g of bupropion is presented. Her hospital course was significant for grand mal seizures, sinus tachycardia without conduction abnormality, and complete neurological recovery. The first pure bupropion overdose in the emergency medicine literature is presented, and the literature pertinent to emergent management of this new antidepressant is reviewed.
-
Multicenter Study Comparative Study
Outcome of insulin-treated diabetics receiving epinephrine during cardiac arrest.
The purpose of this study was to determine the effects of epinephrine in insulin-treated diabetics (DM) compared with nondiabetic (ND) controls during cardiopulmonary resuscitation (CPR). A retrospective analysis from a multicenter study of out-of-hospital cardiac arrest included 62 DM and 1,151 ND. Outcome parameters included return of spontaneous circulation (ROSC), blood pressure (BP), emergency department admissions (EDA), hospital admissions (HA), and hospital discharge (DC). ⋯ However, none of the DM given HDE (n = 24) were discharged from the hospital. These results suggest that DM may have improved resuscitation rates with SDE and may be adversely affected with HDE. Larger prospective studies are needed to confirm these findings.
-
Case Reports
Reversible neurological deficits in a chronic alcohol abuser: a case report of Wernicke's encephalopathy.
The abuse of alcohol presents daily challenges for the emergency medicine physician. Wernicke's encephalopathy represents one of the metabolic complications associated with alcoholism. ⋯ Following administration of intravenous thiamine, the patient's symptoms spontaneously resolved. The pathophysiology, clinical presentation and therapy of this classic disorder are discussed.