The American journal of emergency medicine
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We report a case of a 49-year-old woman with a ruptured liver and spleen found at autopsy, which may have been related to the use of a mechanical cardiopulmonary resuscitation (CPR) device (AutoPulse, ZOLL Medical Corporation, Chelmsford, Mass). She was admitted because of an out-of-hospital resuscitation, and under the suspicion of a pulmonary embolism, a thrombolytic agent was administered. ⋯ The evidence for improved outcomes after the use of a mechanical CPR device during resuscitation is still scarce. To prevent the unique complications reported here, regular checking of proper position of the chest band during resuscitation is advised.
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Necrotizing fasciitis is a severe life-threatening soft tissue infection characterized by rapidly spreading necrosis of the fascia and the subcutaneous tissue. Mortality as a result of streptococcal necrotizing fasciitis has been associated with the presence of hypotension, streptococcal toxic shock syndrome, or bacteremia in the literature. These infections are rare in children, and the diagnosis should be considered in the presence of any soft tissue infection presenting with signs of toxicity and marked wound edema. ⋯ A high index of suspicion is most important when there is a paucity of specific cutaneous findings early in the course of the disease. The diagnosis of necrotizing fasciitis should be considered for any individual who has unexplained limb pain. Even for treating patients with minor trauma, the emergency department physician should keep a high level of suspicion of the possibility of a fatal outcome from the subsequent invasive streptococcal infection.
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Comparative Study
The role of continuous positive airway pressure in acute cardiogenic edema with preserved left ventricular systolic function.
The objective of the study was to compare the effect of continuous positive airway pressure (CPAP) in patients with acute cardiogenic pulmonary edema (ACPE) with preserved or impaired left ventricular systolic function with regard to resolution time. ⋯ The results of this preliminary study show that resolution time is not significantly different in patients with ACPE with preserved or impaired systolic function submitted to CPAP.
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Delayed seizures have been reported with overdoses of bupropion extended-release (XL). This study systematically evaluates the frequency and timing of seizures and an association between other toxic effects (ie, agitation, tremors, and hallucinations) and seizures. ⋯ Delayed seizure onset suggests a minimum observation period of 24 hours after bupropion XL overdose. Although patients experiencing agitation or tremors may be at greater risk, seizures can occur without preceding central nervous system toxicity.
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The advantage of vasopressin over epinephrine in the treatment of cardiac arrest (CA) is still being debated, and it is not clear whether a high dose of vasopressin is beneficial or detrimental during or after cardiopulmonary resuscitation (CPR) in a rat model of CA. In this study, asphyxial CA was induced in 40 male Sprague-Dawley rats. After 10 minutes of asphyxia, CPR was initiated; and the effects of different doses of vasopressin (low dose, 0.4 U/kg; medium dose, 0.8 U/kg; and high dose, 2.4 U/kg; intravenous; n = 10 in each group) and a saline control (isotonic sodium chloride solution, 1 mL, intravenous) were compared. ⋯ However, the heart rate was lower in the high-dose vasopressin group than in the low- and medium-dose groups. These findings indicate that different doses of vasopressin result in a similar outcome of CPR, with no additional benefits afforded by a high dose of vasopressin during or after CPR, in a rat model of asphyxial CA. The mechanism and physiologic significance of the relative bradycardia that occurred in the high-dose vasopressin group are currently unknown and require further investigation.