The American journal of emergency medicine
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Pulmonary hypertension (PH) is one of the most common complications of COPD (chronic obstructive pulmonary disease), but its severe form is uncommon. Various factors play an important role in the occurrence and severity of pulmonary hypertension in patients. ⋯ The results showed that there is an independent correlation between hypoxia, hypopnea and compensatory metabolic alkalosis, polycythemia, left ventricular dysfunction, emaciation, and cachectic with severe pulmonary hypertension. The prevalence of severe PH in these patients was 13.7%.
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Allergic reaction is a common clinical picture in the Emergency Department (ED). Most allergic reactions are from food or drugs. A detailed history is an integral aspect of determining the causative agent of an allergy. ⋯ Lack of universal awareness of this phenomenon in the ED and Urgent Care setting could lead to misdiagnosis, or delayed diagnosis. Subsequently, lack of proper instruction to avoid red meat could put patients at risk for future attacks with morbidity or mortality. We report three cases of allergic reaction presumed from red meat consumption secondary to alpha-gal allergy.
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Primary adrenal failure is considered to be an extremely rare disease presenting in the ED, with an incidence reported to be as low as 50 cases per 1,000,000 persons (Klauer, 2017). I would like to present a case of a young man who presented to the ED, with what I suspected to be this rare entity. ⋯ A 26year old otherwise healthy male presented to our ED with complaints of weakness, nausea, vomiting, and hiccups of 1.5-day duration. He also complained of lightheadedness, describing it as if he was going to pass out. Other than slight tachycardia (100) and darkened skin, his physical exam, ROS, PMH, Family and Social History, were all unremarkable. His sodium returned at 111, and he was later noted to become more confused in the ED prompting the emergent use of Hypertonic Saline. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Albeit a rare disease entity, EPs need to keep this life threatening disease process in the back of their minds when presented with a patient with vague symptoms such as weakness or fatigue, electrolyte abnormalities and darkening of their skin.
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Insulin, as an anti-inflammatory drug, could not be freely used in patients who experienced trauma according to the degree of inflammation, because of the side effect of hypoglycemia. In vivo experimental evidence is lacking concerning whether the effect is dosage dependent and whether it relies on controlling hyperglycemia. ⋯ The effect of anti-inflammation and organ protection of insulin is dosage dependent in vivo; it does not rely on controlling hyperglycemia. Temporary traumatic hyperglycemia itself might not be detrimental to the body. Adjusting the ratio of insulin and glucose could provide a novel train of thought for freely treating patients with severe traumatic injury with different dosages of insulin according to the degree of inflammation.