The American journal of emergency medicine
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Nine consecutive patients presenting with acute gouty arthritis were treated with ketorolac 60 mg intramuscularly (IM). The average age was 58. Seven were male, and six were black. ⋯ There were no side effects of the medication. All of the patients were able to leave the treatment area satisfied with their treatment. None of the patients required crutches at discharge.
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Comparative Study
Diagnostic tests for occult bacteremia: temperature response to acetaminophen versus WBC count.
A cohort of 484 febrile children were examined to (1) assess the utility of temperature response to acetaminophen as a diagnostic test for occult bacteremia (OB) and (2) compare it with the white blood cell (WBC) count. For a period of 18 months, the records of all febrile children seen in the emergency department were reviewed. Testing a response to acetaminophen of a < or = 0.8 degrees C decrease in temperature, the sensitivity, specificity, and positive and negative predictive values were 47%, 74%, 12%, and 95%, respectively. ⋯ The difference was not significant (P > 0.05). The conclusion reached was that temperature response to acetaminophen has predictive values that are similar to the WBC count, and it may provide useful information. However, neither test is impressive, and the clinician cannot reliably predict which febrile children are at risk.
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Cardiovascular deterioration after seizures in tricyclic overdose has long been suspected. The investigators studied a patient with a nortriptyline HCI level of 1,205 ng/mL who had four generalized grand mal seizures, each lasting between 60 and 90 seconds that were immediately followed by hypotension requiring norepinephrine support. When the seizures were controlled with midazolam, the hypotension subsided and norepinephrine was decreased. The metabolic acidosis associated with the seizures may have caused hypotension by direct cardiotoxicity, an increase in bioavailability of tricyclic antidepressant because of changes in protein binding, an alteration of the effects of tricyclic antidepressant on cardiac membrane sodium channels, or a combination of these mechanisms.
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How bretylium tosylate affected the ventricular fibrillation threshold, electrophysiological parameters, and plasma catecholamine levels during hypothermia in dogs was studied. Threshold for ventricular fibrillation was determined by programmed electrical stimulation using a stimulation protocol that involved applying a maximum of five extrastimuli at body temperatures 37, 34, 31, 28, and 25 degrees C, and at the same temperatures during rewarming. Electrocardiogram, epicardial monophasic action potentials (MAP), and electrograms were recorded, and ventricular effective refractory period (VERP) was determined at each of the above temperatures. ⋯ BT had no effect on conduction velocity, and plasma catecholamine levels were not reduced. The antiarrhythmic effect of BT during hypothermia was attributed to an increased wavelength of refractoriness by its increase in the refractory period. This increased wavelength of refractoriness may prevent excitable gaps or increase circuit pathway in the setting of reentry arrhythmias.