The American journal of emergency medicine
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Although patient comfort is a frequent rationale for antipyretic therapy, there have been few systematic studies of relationships between temperature and comfort. In this study, adult outpatients with febrile illnesses were asked to complete a symptom diary at multiple time points at which temperature was recorded. Temperature readings showed modest correlation (0.316) with scores of "feeling better or worse" and moderate correlation (0.586) with aggregate symptom scores. ⋯ Direction of temperature change was not significantly associated with overall subjective score of "feeling better or worse" although aggregate symptom scores were slightly higher with rising than falling temperature. These findings suggest that temperature is a partial determinant of morbidity in minor febrile illnesses but contribution of temperature change to well being may be small. Further study is needed to determine the appropriate priority of temperature reduction in symptomatic therapy.
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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.
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A 22-year-old man with heavy, generalized exposure to a toluene-based paint developed extensive chemical burns on approximately 71% of his total body surface area followed by acute renal failure and disseminated intravascular coagulation that led to death. Although the skin damage initially appeared mild, it was followed by blistering, extensive necrosis, and massive loss of fluid. ⋯ Although the most common toxic effects of toluene are depression of central nervous system activity, irritation of mucous membranes, and hepatic or renal dysfunctions, emergency physicians should be aware of the risk of skin toxicity. Therefore, it is important to irrigate the exposed skin immediately and vigorously.
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Unintentional aspiration of medication capsules is a rare event. A case report of a neurologically impaired 23-year-old woman who aspirated a 50-mg nortriptyline capsule is presented. This resulted in progressive respiratory distress necessitating ventilatory support. Bronchoscopy showed severe airway inflammation and edema.
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Hemolytic uremic syndrome (HUS), the most common cause of acute renal failure in childhood, has the potential to progress to a life-threatening illness. Its incidence in North America is increasing. ⋯ This case exemplifies what appears initially as gastroenteritis but, ultimately, becomes the final diagnosis of HUS. A case is presented to provide additional education to ensure the E coli O157:H7 infection is considered in the differential diagnosis of persons who present with bloody diarrhea.