J Emerg Med
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Four patients presented to the emergency department with acute dystonic reactions 36 hours after the ingestion of "Valium tablets" they purchased on the street. Complete reversal of the symptomatology was achieved with the use of intramuscular diphenhydramine. The pathophysiology, epidemiology, and treatment principles for dystonic reactions are discussed.
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In two patients, persistent hiccups were an unusual presenting manifestation of hyponatremia. Persistent hiccups occur in a variety of serious diseases, including metabolic and electrolyte disorders. They may cause the victim significant distress and may be refractory to most treatments. Hiccups lasting more than 24 hours require investigation for an underlying organic etiology, with hyponatremia included in the differential diagnosis.
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Case Reports
The blue scrotum sign of Bryant: a diagnostic clue to ruptured abdominal aortic aneurysm.
A 73-year-old man presented to the emergency department twice with nonspecific abdominal pain. He was diagnosed as having mild diverticulitis and was discharged. ⋯ After an initial urologic consultation the correct diagnosis of ruptured abdominal aortic aneurysm was made. We discuss the pathogenesis of the genital discoloration and make the correct historical attribution of this sign to John Henry Bryant, a turn-of-the-century physician at Guy's Hospital.
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Case Reports
Emergency transcutaneous pacing in the management of patients with bradyasystolic rhythms.
Survival rates in cases of bradyasystolic cardiac arrest are uniformly low, being reported at from 0% to 3%. Recent advances in technology and microcircuitry have produced lightweight, portable external pacing devices that are less painful to the patient. In an on-going clinical trial of early transcutaneous pacing, five cases were seen in which transcutaneous pacing was begun at the onset of the patients' rhythm disturbance. ⋯ Three of the patients were treated in the prehospital setting. Because of the rapidity with which pacing can be implemented, the ease of application and simplicity of operation, transcutaneous pacing has several advantages over the placing of transvenous pacemakers in the field or emergency department setting. In hemodynamically-compromising bradydysrhythmias unresponsive to pharmacologic intervention, the early use of transcutaneous pacing may improve survival in a group of patients who might otherwise die.