The American journal of emergency medicine
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The objective of this study was to evaluate the overall impact of serum amylase determinations in the initial management of patients presenting to the pediatric emergency department (ED) with the acute onset of abdominal pain or trauma. All cases of patients younger than 18 years of age who presented to the pediatric ED for whom a serum amylase value was determined during an 18-month period were reviewed. Data were collected retrospectively, including serum amylase concentration, age, gender, presenting complaint, discharge/admission status, diagnosis, and discharge plans or inpatient management to evaluate the impact of serum amylase determinations. ⋯ Of the 12 patients with elevated amylase levels sent for abdominal pain or trauma, only 2 had their clinical management affected by the serum amylase concentration. In both cases, the patient presented with subacute abdominal pain related to significant abdominal trauma that had occurred 2 to 3 weeks earlier. Both patients showed evidence of pancreatic insult with diagnostic imaging studies.(ABSTRACT TRUNCATED AT 250 WORDS)
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Although patient comfort is a frequent rationale for antipyretic therapy, there have been few systematic studies of relationships between temperature and comfort. In this study, adult outpatients with febrile illnesses were asked to complete a symptom diary at multiple time points at which temperature was recorded. Temperature readings showed modest correlation (0.316) with scores of "feeling better or worse" and moderate correlation (0.586) with aggregate symptom scores. ⋯ Direction of temperature change was not significantly associated with overall subjective score of "feeling better or worse" although aggregate symptom scores were slightly higher with rising than falling temperature. These findings suggest that temperature is a partial determinant of morbidity in minor febrile illnesses but contribution of temperature change to well being may be small. Further study is needed to determine the appropriate priority of temperature reduction in symptomatic therapy.
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Allergic reactions and complications of diabetes mellitus are commonly seen in emergency departments and primary care settings. Although stress is a known contributor to the development of diabetic ketoacidosis (DKA), anaphylaxis-induced DKA has not previously been described. ⋯ It was concluded that stress and counter-regulatory hormones released during anaphylaxis, as well as the treatment with epinephrine and glucocorticoids, precipitated DKA in this patient despite ongoing insulin and fluid therapy. Type 1 diabetic patients experiencing anaphylaxis may require prolonged periods of observation and measurement of serial blood glucose and urine ketones.
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Hemolytic uremic syndrome (HUS), the most common cause of acute renal failure in childhood, has the potential to progress to a life-threatening illness. Its incidence in North America is increasing. ⋯ This case exemplifies what appears initially as gastroenteritis but, ultimately, becomes the final diagnosis of HUS. A case is presented to provide additional education to ensure the E coli O157:H7 infection is considered in the differential diagnosis of persons who present with bloody diarrhea.
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Unintentional aspiration of medication capsules is a rare event. A case report of a neurologically impaired 23-year-old woman who aspirated a 50-mg nortriptyline capsule is presented. This resulted in progressive respiratory distress necessitating ventilatory support. Bronchoscopy showed severe airway inflammation and edema.