J Emerg Med
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Review Case Reports
Minoxidil overdose with ECG changes: case report and review.
A 20-year-old female ingested an unknown quantity of minoxidil tablets as a suicide gesture. She presented to the emergency department about 90 minutes later with tachycardia, diffuse T wave inversion, and S-T segment depression on the ECG, labile hypotension, and a substantially elevated total serum minoxidil concentration of 3140 ng/mL. She responded to supportive therapy with intravenous fluids, and was discharged 32 hours later with stable blood pressure and mild residual tachycardia. The clinical toxicology, treatment, and previous case reports of minoxidil overdose are reviewed.
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Neurogenic pulmonary edema (NPE) is a relatively common though often subclinical complication of a variety of central nervous system insults (trauma, hemorrhage, seizures, etc.) in children and adults. The syndrome probably results from massive centrally mediated sympathetic discharge and generalized vasoconstriction, and often presents in the emergency department (ED). ⋯ Treatment consists of ventilatory support, including positive end-expiratory pressure, and aggressive measures to reduce intracranial pressure. We present four cases of NPE and review its recognition and emergent management.
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A 41-year-old man presented with respiratory distress and hypotension after a 30-foot fall from a tree. Despite fluid resuscitation, the patient expired in the operating room. ⋯ Azygos vein and superior vena caval lacerations are rare following blunt chest trauma, including vertical deceleration injury. Early suspicion of vascular injuries with aggressive fluid resuscitation and surgical intervention remain the only hope for survival from this highly lethal injury.
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Herniation of abdominal viscera into the thorax following traumatic diaphragmatic hernia can simulate acute tension pneumothorax. A case is presented of a blunt trauma victim with apparent acute diaphragmatic rupture, tension hemothorax, or tension hemopneumothorax. Nasogastric tube insertion demonstrated tension gastrothorax, but was followed by acute clinical decompensation. ⋯ Although nasogastric tube placement should be attempted first, it may exacerbate the condition. Percutaneous needle decompression of the stomach through the chest wall can stabilize the situation and is safer and more rapid than chest tube placement, which might be either ineffective or dangerous. Paralyzing the patient with acute diaphragmatic rupture before tracheal and gastric intubation might prevent progression to tension gastrothorax.
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This article outlines the objectives for a resident rotation in pulmonary diseases. It is part of a continuing series on the goals and objectives to direct Emergency Medicine resident training on off-service rotations. ⋯ The objectives of this article are viewed as a one-month component of an Internal Medicine Rotation in the first year of training. These objectives are designed to help focus the resident's reading and study during a pulmonary off-service rotation.