The American journal of emergency medicine
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We report a case of atorvastatin-induced hypersensitivity reaction in a 58-year-old male following first exposure to the drug. The patient took one dose of atorvastatin 40 mg and presented to the emergency department (ED) within 24 h with a chief complaint of throat swelling, trouble swallowing, and throat pain. The patient did not have pruritis or skin manifestations. ⋯ Statin-induced hypersensitivity reactions could be explained by statins' effects on bradykinin 2 receptors that potentiate vasodilation and leading to angioedema. In the literature, cases of hypersensitivity associated with atorvastatin present after months of cumulative exposure. Therefore, this case is unique in that a reaction developed within 24 h of that first dose.
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Testicular torsion is a serious condition that carries with it a high rate of morbidity. ⋯ An understanding of testicular torsion can assist emergency clinicians in diagnosing and managing this disease.
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Meta Analysis
Mobile integrated health-community paramedicine programs' effect on emergency department visits: An exploratory meta-analysis.
Mobile Integrated Health Community Paramedicine (MIH-CP) programs are designed to increase access to care and reduce Emergency Department (ED) and Emergency Medical Services (EMS) usage. Previous MIH-CP systematic reviews reported varied interventions, effect sizes, and a high prevalence of biased methods. We aimed to perform a meta-analysis on MIH-CP effect on ED visits, and to evaluate study designs' effect on reported effect sizes. We hypothesized biased methods would produce larger reported effect sizes. ⋯ Our data revealed MIH-CP programs were associated with a reduced risk of ED visits. Study design did not have a statistically significant influence on effect size, though it did influence heterogeneity. We would recommend future studies continue to use high levels of control to produce reliable data with lower heterogeneity.
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Randomized Controlled Trial
A novel cardiac arrest severity score for the early prediction of hypoxic-ischemic brain injury and in-hospital death.
Out-of-hospital cardiac arrest (OHCA) outcomes are unsatisfactory despite postcardiac arrest care. Early prediction of prognoses might help stratify patients and provide tailored therapy. In this study, we derived and validated a novel scoring system to predict hypoxic-ischemic brain injury (HIBI) and in-hospital death (IHD). ⋯ We presented a novel approach for assessing illness severity after OHCA. Although external prospective studies are warranted, risk stratification for HIBI and IHD could help provide OHCA patients with appropriate treatment.
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Cardiogenic shock (CS) is associated with high morbidity and mortality. In recent times, there is increasing interest in the role of angiotensin II in CS. We sought to systematically review the current literature on the use of angiotensin II in CS. ⋯ In this first systematic review of angiotensin II in CS, we note the early clinical experience. Angiotensin II was associated with improvements in MAP, decrease in vasopressor requirements, and minimal reported adverse events.