The American journal of emergency medicine
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Clinical Trial
Prochlorperazine in children with migraine: a look at its effectiveness and rate of akathisia.
The objective of this study is to evaluate the effectiveness of prochlorperazine and the rate of akathisia in children with severe migraine. ⋯ Prochlorperazine seems very effective to decrease pain on a short-term basis in children. However, more than two thirds of the patients, overall, had a relapse of their migraine at home in the first week. Despite the use of diphenhydramine, akathisia remains a concern.
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It is often difficult to diagnose acute myocardial infarction (AMI) in patients who resuscitated after out-of-hospital cardiac arrest (OHCA) and had a delayed elevation in cardiac marker. This study explored whether elevations in cardiac marker were due to coronary artery occlusion or resulted from other causes. ⋯ The resuscitation of patients who experience sudden OHCA but do not have an AMI may lead to elevations of cardiac markers. However, these elevations are low and normalize early.
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Glucocorticoid administration is not recommended in patients with heart failure because of its related sodium and fluid retention. However, previous experimental and clinical studies have demonstrated that glucocorticoids can also induce a diuretic effect and improve renal function in patients with acute decompensated heart failure (ADHF) with refractory diuretic resistance. We report the case of a 65-year-old man with a known diagnosis of aortic stenosis, systolic ventricular dysfunction, and chronic obstructive pulmonary disease who was admitted for ADHF. ⋯ Bioimpedance vector analysis showed a net reduction of fluid content (from 88.4% to 73.6% of hydration at discharge). In conclusion, this case report suggests that in a patient with ADHF and congestion resistant to diuretic therapy, glucocorticoid administration is safe and associated with improvement in congestion, neurohormonal status, and renal function. These data support the possible usefulness of glucocorticoids in this setting.
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Several drugs used in psychiatry may induce constipation, paralytic ileus, or acute megacolon (Ogilvie's syndrome). We report here 2 cases of patients presenting with fatal abdominal compartment syndrome related to the absorption of antidepressants and benzodiazepines. Two patients (a 27-year-old man and a 57-year-old woman) with a previous psychiatric history and treatment with psychiatric drugs were admitted to the emergency department for coma. ⋯ In both cases, the abdominal scan showed massive colonic dilatation without mechanical obstruction; there was even aortic compression and ischemia of the abdominal viscera. Emergency laparotomy with bowel decompression was performed in both cases, but multiple organ failure led to death in both patients. Psychiatric drugs may induce acute severe megacolon with life-threatening abdominal compartment syndrome.
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Comparative Study
The implications of abdominal palpation with Ou MC manipulation for women with acute abdomen.
Abdominal palpation with Ou MC manipulation (APOM) has showed to be more sensitive than bimanual pelvic examination for the diagnosis of pelvic inflammatory disease in women with acute abdomen (JEM. 2010;). This study compared APOM with traditional abdominal palpation (AP) for diagnostic reliability and enquired into the mechanism of APOM. ⋯ The delimitation by APOM as a separation zone may allow positional recognition of the tenderness with decreased overlap of signs. However, in cases with muscle guarding, initial APOM might not be able to locate tenderness effectively until repeated APOM or APOMs with aggravated isolation lead to extensive space shielding and isolation of visceral organs. This implies that tenderness location by APOM may also relate to space shielding and pelvic organ isolation.