The American journal of the medical sciences
-
Review Case Reports
Acute myocardial infarction after a local anesthetic procedure in a middle-aged patient.
We report a case of acute myocardial infarction (AMI) occurring after a local injection of lidocaine. The patient presented with symptoms of myocardial ischemia, dynamic changes in the ST segment of the electrocardiogram, and significantly elevated levels of cardiac troponin; however, coronary angiography findings were normal. According to the clinical definition of AMI, these features indicated the presence of acute myocardial injury, reflected by abnormal cardiac biomarkers and supported by evidence of acute myocardial ischemia. ⋯ The potential mechanism in this case may be lidocaine-induced coronary artery spasm. The possible serious side effects of lidocaine require the attention and vigilance of clinicians. To our knowledge, this is the first report to describe coronary artery spasm possibly induced directly by lidocaine.
-
Sepsis is one of the leading causes of hospital mortality, and diabetes is a risk factor for the development of infections. Although strong evidence has shown an association between metformin and reduced risk of infections, the risk of developing infections with newer classes of oral anti-diabetic drugs (OADs) has been less certain. Our study aims to examine the association between outpatient OAD use and hospital admissions for infections. ⋯ Metformin was associated with lower odds of hospital admission for infection while meglitinides, SGLT2 inhibitors, alpha-glucosidase inhibitors, and DPP4 inhibitors were associated with higher odds of admission for infection.
-
Recent studies suggest that balanced fluids improve inpatient outcomes compared to normal saline. The objective of this study was to obtain insights into clinicians' knowledge, attitudes and perceived prescribing practices concerning IV isotonic fluids and to analyze perceived prescribing in the context of actual prescribing. ⋯ Persistent normal saline utilization is associated with certain specialties, care locations, and the rate and volume of fluid administered, but not with other clinical considerations or cost. These findings can guide interventions to improve evidence-based fluid prescribing.