The American journal of emergency medicine
-
Randomized Controlled Trial Comparative Study Clinical Trial
Efficiency of whole bowel irrigation with and without metoclopramide pretreatment.
Whole bowel irrigation (WBI) with a polyethylene glycol electrolyte lavage solution (PEG-ELS) is a gastrointestinal (GI) decontamination procedure used after selected ingestions of toxic substances. The purpose of this study was to evaluate the ability of WBI, with and without metoclopramide pretreatment, to clear the GI tract of foreign bodies using previously established WBI end points, ie, the presence of a clear effluent or the administration of 2 L/h PEG-ELS for 5 hours. Eleven healthy, adult, male volunteers participated in this controlled, two-phase, blinded, crossover study. ⋯ For the placebo group, the mean number of beans passed was equal to 3.5 (+/- 1.9 SD; 2 to 7 R), and the mean number at clear effluent was equal to 2.3. In conclusion, the presence of a clear effluent or the administration of 10 L of PEG-ELS are not valid markers for the termination of WBI if complete elimination of a foreign body is required. Pretreatment with 10 mg of oral metoclopramide does not enhance the efficiency of WBI.
-
Review Case Reports
Aortic dissection presenting as superior vena cava syndrome.
Aortic dissection usually presents with chest pain, abnormal pulses, and a widened mediastinum on chest radiograph. It is rarely associated with the superior vena cava syndrome (SVCS), which more commonly occurs in the setting of malignant disease. A patient who had SVCS as a result of a painless aortic dissection is presented and compared with other previously reported cases of simultaneous SVCS and aortic dissection.
-
Psychiatric emergencies in the elderly form a small percent of all elderly patients treated in emergency departments. However, accurately diagnosing and understanding behavioral emergencies in the elderly is difficult. ⋯ Causes of these syndromes in the elderly include delirium, dementia, medication side effects, physical illnesses, depression, and alcohol intoxication/dependency. Emergency physicians should consider each of these diagnostic possibilities when evaluating elderly behavioral emergencies to properly diagnose and treat elderly patients.
-
Eikenella corrodens, a fastidious, slow-growing, gram-negative, facultative anaerobic bacillus may be encountered in wounds exposed to human saliva, especially human bites and head and neck infections. An unusual case of a mixed flora E corrodens and Streptococcus septic arthritis with adjacent osteomyelitis secondary to saliva contamination from licking an intravenous (i.v.) needle is presented. A literature search showed 53 previous cases of E corrodens infections in i.v. drug users. ⋯ Recommendations for treatment include penicillin or ampicillin. Tetracycline is recommended in the penicillin-allergic patient. This is the first case that draws attention to the connection between E corrodens, i.v. drug use, and septic arthritis and osteomyelitis.
-
A retrospective review of cases consulted by the San Francisco Bay Area Regional Poison Control Center during a 2-year period was performed to determine the causes and consequences of seizures associated with poisoning and drug intoxication. Of 233 charts coded as involving seizures, 191 occurred in humans and were available for analysis. The leading causes of seizures reported to the Poison Control Center were cyclic antidepressants (55 cases, 29%); cocaine and other stimulants (55 cases, 29%); diphenhydramine and other antihistamines (14 cases, 7%); theophylline (10 cases, 5%); and isoniazid (10 cases, 5%). ⋯ Seizures in elderly patients were more likely to result in complications and death. The frequency of seizure-related cases by substance type was also compared with the results of an earlier survey performed in 1981, and found a striking increase in the proportion of seizures caused by cocaine and (23% in 1988 to 1989 compared with 4% in 1981). Poison Control Center data can provide valuable information about the causes and consequences of drug-related medical complications, as well as highlight changing trends in drug-related injury.