European journal of emergency medicine : official journal of the European Society for Emergency Medicine
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Case Reports
Diltiazem poisoning treated with hyperinsulinemic euglycemia therapy and intravenous lipid emulsion.
Intravenous lipid emulsion (ILE) has been proposed as a rescue therapy for severe local anesthetic drugs toxicity, but experience is limited with other lipophilic drugs. An 18-year-old healthy woman was admitted 8 h after the voluntary ingestion of sustained-release diltiazem (3600 mg), with severe hypotension refractory to fluid therapy, calcium salts, and high-dose norepinephrine (6.66 μg/kg/min). ⋯ Diltiazem is a lipophilic cardiotoxic drug, which could be sequestered in an expanded plasma lipid phase. The mechanism of action of ILE is not known, including its role in insulin resistance and myocardial metabolism in calcium-channel blocker poisoning.
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As a result of national guidance in the UK, the number of computed tomography brains performed in patients with minor head injury has increased significantly. The aim of this survey was to establish the requirement for general anaesthesia and tracheal intubation in the management of emergency department patients requiring an urgent computed tomography of the brain. About 300 consecutive scans in emergency department patients were reviewed. The majority (>90%) did not require anaesthetic airway management despite an overall acute scan diagnosis rate of around 25% and 30 day mortality of 10%.
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Atraumatic splenic rupture is an uncommon but poorly defined clinical condition. Its diagnosis may be missed or delayed because of low clinical suspicion, especially in the absence of trauma. The primary aim of this study was to describe the experience with atraumatic splenic rupture in a district general hospital. ⋯ In four cases, no pathological abnormality was identified (atraumatic-idiopathic); abnormal pathologies (atraumatic-pathological) in the remaining three were amyloidosis, lymphoma and focal thrombosis. A high index of suspicion should be maintained by emergency physicians and surgeons during initial evaluation of these patients. Computed tomography scan facilitates the diagnosis and early total splenectomy is often needed.
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Comparative Study
A comparison of autopsy detected injuries in a porcine model of cardiac arrest treated with either manual or mechanical chest compressions.
The objective of this study was to evaluate and compare the complications of cardiopulmonary resuscitation after manual or mechanical chest compressions in a swine model of ventricular fibrillation. In this retrospective study, 106 swine were treated with either manual (n=53) or mechanical chest compressions with the LUCAS device (n=53). All swine cadavers underwent necropsy. ⋯ Nine animals in the manual, and two in the LUCAS group had liver hematomas (P=0.026%). In the manual group, eight animals were detected with spleen hematomas whereas no such injury was identified in the LUCAS group (P=0.003). LUCAS devise minimized the resuscitation-related trauma compared with manual chest compressions in a swine model of cardiac arrest.