The American journal of emergency medicine
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Poisoning caused by calcium-channels blockers (CCB) can cause refractory vasoplegic shock, resulting in multiple-organ failure and death despite maximal therapy including high doses of vasopressors. We report one CCB-induced refractory shock complicated with lactate acidosis despite very high doses of epinephrine and norepinephrine. The hemodynamic status of the patient dramatically improved after intermittent boluses of terlipressin, which corrected the acidosis.
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Overcrowding in the Emergency Department is a problem with many strategies for intervention such as the physician in triage (PIT). This brief evaluation is designed to minimize diagnostic uncertainty and expedite the work up when the patient is seen in the Emergency Department. We hypothesized that this would increase CT imaging which would be increasingly negative as the pressure to maintain throughput rises on busy days in the Emergency Department. ⋯ There is no difference in CT ordering patterns for abdominal pain by PIT between HD5 and LD5. Likewise CT ordering patterns do not demonstrate a difference in percentage of clinically relevant CTs.
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A 21year-old male presented to the emergency department with 6 h of atypical chest pain after suffering blunt chest trauma. His electrocardiogram revealed 1-1.5mm ST segment elevation in leads V1-V3 with reciprocal depressions in II, III, and aVF. ⋯ A left main coronary artery dissection was diagnosed and treated surgically with a bypass graft. Although rare, coronary dissections can be a catastrophic complication of chest trauma.
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Case Reports
Acute generalized exanthematous pustulosis secondary to levetiracetam and valproic acid use.
Acute generalized exanthematous pustulosis (AGEP) is a rare cutaneous eruption characterized by the appearance of diffuse, sterile pustules on an erythematous and edematous base. Most cases are attributed to drug reactions, with antibiotics being the most common offending agents. ⋯ The patient presented to the emergency department with the characteristic AGEP rash, fever, and leukocytosis. Upon discontinuation of the two medications and conservative management, the patient's symptoms quickly abated, and she was discharged from the hospital several days later.