J Emerg Med
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Upper airway obstruction due to a subglottic tumor can be easily misdiagnosed as bronchial asthma. We report on a 50-year-old woman who was ultimately diagnosed with subglottic tumor, but who presented with near-fatal asthma. According to her medical history she had been treated with high doses of prednisolone and bronchodilators for the past year for difficult asthma. ⋯ After the operation, all symptoms and respiratory distress disappeared. This case report emphasizes the fact that not all wheezes are attributable to asthma. Upper airway obstructions can lead to asthma-like symptoms in which establishment of the correct diagnosis may be challenging.
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We sought to determine Emergency Department (ED) patient preference for oral (p.o.), intramuscular (i.m.), or intravenous (i.v.) pain medication and patient expectations of time to medication effect by route. A prospective, observational study of 1276 patients presenting with painful illness or injury was performed in a university ED. Patient preferences were 66% p.o., 15% i.m., and 19% i.v. pain medication. ⋯ Despite these differences, a majority of patients in all groups preferred oral medications. There were no differences in preference based on ethnicity or gender. Patient expectations for time to pain medication effect were 27 min p.o. (95% CI 26-28), 12 min i.m. (95% CI 11-13), and 7.5 min i.v. (95% CI 6.9-8.0).
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Case Reports
Cervical epidural abscess associated with massively elevated erythrocyte sedimentation rate.
We present a case of an elderly woman who presented with neck pain, low-grade fever, bandemia, and a massively elevated erythrocyte sedimentation rate (ESR) who had a cervical epidural abscess. We believe that the selective use of ESR assisted in narrowing the differential diagnosis, as the patient had no neurological deficits and no predisposing factors such as distal infection, immunosuppression, trauma, or recent surgery. Furthermore, in the literature, an elevated ESR is consistently found in patients with epidural abscesses, whereas clinical findings such as fever, leukocytosis, and neurological deficits are only variably present.
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Classically described antimuscarinic poisoning signs and symptoms include mydriasis, decreased secretions, ileus, urinary retention, hyperthermia, tachycardia, and altered mental status. These features may be used clinically to assist in the diagnosis of patients with unknown poisonings. We sought to analyze the prevalence of antimuscarinic physical examination findings in evaluating patients presenting with acute poisoning from antimuscarinic agents. ⋯ At least one of these three signs was documented in 94% of our patients. The combination of tachycardia and decreased secretions was the most common pair of findings, recorded in 55.4% of cases. We conclude that the clinical presentation of antimuscarinic syndrome is variable.