The American journal of emergency medicine
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The aim of this study was to evaluate the diagnostic and the prognostic value of a laboratory panel consisting of mid-regional pro-atrial natriuretic peptide (MR-proANP), procalcitonin (PCT), and mid-regional pro-adrenomedullin (MR-proADM) for patients presenting to the emergency department (ED) with acute dyspnea. ⋯ The good negative LR- of MR-proANP and the good positive LR+ of PCT may suggest a role for these markers in the early diagnosis of ED patients with dyspnea. Furthermore, MR-proADM may assist in risk stratification and prognosis in these patients..
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Survival after in-hospital cardiac arrest (CA) has been reported to be surprisingly low without any major improvement during the last decade. ⋯ An intervention within 1 single hospital (systematic training of all health care professionals in cardiopulmonary resuscitation and implementation of automated external defibrillators) did not reduce treatment delay or increase overall survival. Our results, however, suggest indirect signs of an improved cerebral function among survivors.
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We report a case of traumatic floating clavicula in a man aged 21 years. He was admitted to our emergency department with polytrauma sustained in a motor car accident, successfully treated 21 days after the accident with bipolar open reduction and wire stabilization.
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Adenosine is widely used for the treatment of supraventricular tachycardias for its efficacy and excellent safety, but it has been reported to precipitate severe bronchospasm in patients with pulmonary disease. The drug is therefore contraindicated in asthmatic subjects and should be used with caution in patients with chronic obstructive pulmonary disease. Nevertheless, true bronchospasm is rare and should be distinguished from the much more common occurrence of dyspnea, only as a symptom and without respiratory compromise, which is benign and transient. ⋯ He was treated with oxygen and inhaled and intravenous steroids, but dyspnea and bronchospasm resolved only after intravenous aminophylline. The arrhythmia recurred and was finally terminated by intravenous flecainide. Although dyspnea after adenosine administration is usually a transient, benign phenomenon, physicians should be alert to the presence of objective signs of respiratory distress, which should prompt immediate treatment, even in subjects without previous history of pulmonary disease.
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Fever is the most common precipitant of status epilepticus in children. Animal models suggest that only γ-aminobutyric acidic drugs are effective in the treatment of febrile seizures, but there is limited clinical evidence to support this. ⋯ Phenytoin is rarely effective in controlling febrile status epilepticus. Children exposed to phenytoin have more prolonged febrile seizures, increasing the risk of brain injury.