J Emerg Med
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Antihypertensive medications, including β-blockers, are widely used in patients with chronic kidney disease. Unlike most β-blockers, atenolol is excreted primarily by the kidney, and its clearance by peritoneal dialysis is poor. These pharmacokinetic factors may predispose patients to gradual accumulation of the drug over time. ⋯ The unique pharmacokinetics of long-term medications must be considered in patients with impaired clearance, such as this patient with end-stage renal disease treated by peritoneal dialysis. Medications may gradually accumulate to supratherapeutic levels, which over time may lead to symptoms of significant toxicity.
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Despite the publication of recent guidelines for anaphylaxis management, many studies show that physicians are still not at ease with the management of anaphylaxis. ⋯ Medication errors in the management of anaphylaxis were frequent. Use of an SOF significantly reduced the rate of dosage errors.
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Bedbug infestations are increasing across North America and Europe, with more people presenting to Emergency Departments for treatment. Physicians cannot provide substantive treatment for people affected by bedbugs. ⋯ It may be possible that ivermectin could help eradicate, suppress, or prevent a bedbug infestation.
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High-dose corticosteroid therapy is used to treat several severe autoimmune diseases. Despite a common knowledge in the medical community of the adverse effects of chronic corticosteroid use, there is much less awareness of the affects that can occur after very high doses are administered in a relatively short period of time. ⋯ More patients with autoimmune diseases may be placed on outpatient-based treatment regimens of high-dose corticosteroids in the future. It is important for emergency physicians to be aware of bradycardia as a possible adverse effect, as many of these patients may present to the emergency department for evaluation.
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As prehospital emergency rescuers prepare cervical spine-injured adult patients for immobilization and transport to hospital, it is essential that patients be placed in a favorable position. Previously, it was recommended that patients with cervical spine injuries be immobilized in a slightly flexed position using pads placed beneath the head. However, it is unknown how neck flexion created with pad placement affects the unstable spine. ⋯ Because the goal of emergency rescuers is to conserve whatever physiologic or structural integrity of the spinal cord and spinal column that remains, the outcome of this study suggests that this goal may be best achieved using the "no pad" condition. However, it is recommended that more research be conducted to confirm these preliminary findings.