The American journal of emergency medicine
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The objective of this study was to evaluate the overall impact of serum amylase determinations in the initial management of patients presenting to the pediatric emergency department (ED) with the acute onset of abdominal pain or trauma. All cases of patients younger than 18 years of age who presented to the pediatric ED for whom a serum amylase value was determined during an 18-month period were reviewed. Data were collected retrospectively, including serum amylase concentration, age, gender, presenting complaint, discharge/admission status, diagnosis, and discharge plans or inpatient management to evaluate the impact of serum amylase determinations. ⋯ Of the 12 patients with elevated amylase levels sent for abdominal pain or trauma, only 2 had their clinical management affected by the serum amylase concentration. In both cases, the patient presented with subacute abdominal pain related to significant abdominal trauma that had occurred 2 to 3 weeks earlier. Both patients showed evidence of pancreatic insult with diagnostic imaging studies.(ABSTRACT TRUNCATED AT 250 WORDS)
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This prospective study was designed to quantify the effect of epinephrine on end-tidal PCO2 (PetCO2) during prehospital cardiopulmonary resuscitation (CPR) in humans. It included 20 patients (age range, 26 to 90 years) who presented in ventricular asystole on arrival of the prehospital medical team. Protocol began 5 minutes after tracheal intubation and during chest compressions. ⋯ There was a significant relationship between the epinephrine-induced change in PetCO2 and the PetCO2 value before epinephrine injection (r = .760; P < .0001). This study demonstrates a variable decrease in PetCO2 after IV epinephrine injection during CPR. Isolated PetCO2 readings may be misleading in assessing CPR efficacy or predicting outcome, and continuous measurement is recommended.
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Psychiatric emergencies in the elderly form a small percent of all elderly patients treated in emergency departments. However, accurately diagnosing and understanding behavioral emergencies in the elderly is difficult. ⋯ Causes of these syndromes in the elderly include delirium, dementia, medication side effects, physical illnesses, depression, and alcohol intoxication/dependency. Emergency physicians should consider each of these diagnostic possibilities when evaluating elderly behavioral emergencies to properly diagnose and treat elderly patients.
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Low back pain is uncommon in children. The case of a 5-year-old boy presenting with back pain that proved to be caused by a metastatic primitive neuroectodermal tumor is presented and the evaluation of such patients is discussed.
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A case of carbon monoxide (CO) poisoning with severe myonecrosis and acute renal failure (ARF) is presented with extremely high values of CPK but with preservation of myocardial tissue. A discussion of the broad effects of CO intoxication is undertaken with a review of the pertinent literature. Diagnostic and therapeutic mainstays are presented with some pitfalls and alternatives to their implementation. Computed tomography of affected muscles is presented as an alternative to muscle biopsy, and a unique modality of noninvasive diagnosis of myonecrosis.