The American journal of emergency medicine
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Churg-Strauss syndrome (CSS) is a rare vasculitic disorder characterized by chronic rhinosinusitis, asthma, and persistent eosinophilia. Although not a usual prominent initial presentation, cardiac involvement is a major cause of morbidity and mortality in patients with CSS. We report a case of a 72-year-old white man who presented with chest pain and was subsequently diagnosed with CSS with biopsy-proven eosinophilic myopericarditis. We have also included a review of the literatures on cardiac involvement in CSS.
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Sedations after endotracheal intubation (ETI) reduce the risk of self-extubation, uncontrolled pain, and myocardial infarction. Although several small single-center studies demonstrate low rates of sedative drug administration after ETI in the emergency department (ED), little is known regarding post-ETI sedative drug practices nationally. ⋯ Less than one-half of patients undergoing ETI in the ED receive sedative drugs while in the ED. These findings are congruent with prior smaller studies from single academic centers.
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Anaphylaxis is a life-threatening reaction treated primarily with epinephrine. Methylene blue, a competitive inhibitor of guanylate cyclase, interferes with the vasodilatory actions of nitric oxide. It has recently been proposed by the Joint Taskforce on Practice Parameters as an alternative treatment for anaphylaxis with hypotension that is not responsive to classical therapy. ⋯ After infusion of methylene blue, symptom resolution occurred almost immediately, and intubation was spared. Side effects were minimal. We propose methylene blue as a safe treatment option for refractory anaphylaxis, whether with or without hypotension.
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Reactive arthritis is an inflammatory condition with multiorgan system disease potential. Because the standard constellation of symptoms in Reiter syndrome (arthritis, conjunctivitis, and urethritis) is not typically present in all patients, the disease can be easily overlooked if clinical suspicion is not high upon presentation. To highlight the importance of recognizing the potential of this disease in patients with a history of either gastrointestinal or genitourinary illnesses, we present the case of a young healthy male presented on multiple occasions later diagnosed with Reiter syndrome in the setting of a recent diagnosis of prostatitis. ⋯ He was treated with nonsteroidal anti-inflammatory drugs during a brief hospital stay and did well. Although reactive arthritis is an easily managed disease, it is easily missed particularly in young otherwise healthy patients who may not present with classic symptoms. Vigilance with regard to patients with vague seemingly unrelated complaints particularly with a history of gastrointestinal- or genitourinary-related illnesses deserves consideration for this disease process.
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Comparative Study
The effects of 3 different compression methods on intrathoracic pressure in a swine model of ventricular fibrillation.
The aim of this study was to provide a realistic comparison of 3 different extracorporeal compression methods during cardiopulmonary resuscitation on intrathoracic pressure (ITP), hemodynamics, and oxygen metabolism in a swine model of ventricular fibrillation (VF). ⋯ Mechanical compression cannot replace traditional artificial manual compression, which remains the preferred method for cardiopulmonary resuscitation.