The American journal of emergency medicine
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Comparative Study Clinical Trial
Contrast enhanced ultrasound vs chest X-ray to determine correct central venous catheter position.
We aimed to analyze the diagnostic accuracy of contrast enhanced ultrasonography (CEUS), compared with chest x-ray (CXR), in the detection of correct central venous line (CVL) placement. Our hypothesis was to verify whether CEUS could substitute CXR as a reference standard for correct placement of CVL or function as a triage test to limit the execution of CXR only for selected patients. ⋯ CEUS can't substitute CXR, or become a triage test in selected patients, in evaluating the correct tip position after CVL placement.
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Despite the fact that caffeine is the most commonly used stimulant in modern society, cases of caffeine overdose are relatively rare, with fatalities reported from doses of 10 g and higher (Nord J Psychiatry. 2006;60:97-106). Large doses produce symptoms associated with stimulation of the cardiovascular, central nervous, and gastrointestinal symptoms (Associates of the California Poison Control Center, Poisoning and Drug Overdose, pp. 142-143. 5th Ed). We present the first reported case of a man with delayed presentation to the emergency department after ingesting 24 g of caffeine in a suicide attempt who suffered complications of severe rhabdomyolysis and acute renal failure requiring subsequent hemodialysis.