Brit J Hosp Med
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A young woman presented with severe chest pain and an inverted takotsubo cardiomyopathy following adrenaline injection for treatment of an allergic reaction. To the authors' knowledge, this is the first reported case of inverted takotsubo cardiomyopathy following systemic adrenaline administration. The case strongly suggests a central role of catecholamines in the pathogenesis of takotsubo cardiomyopathy.
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Supportive therapy with extracorporeal membrane oxygenation for acute respiratory distress syndrome.
Acute respiratory distress syndrome is a severe form of respiratory failure characterized by acute onset of significant hypoxaemia (PaO2:FiO2<200mmHg) with diffuse bilateral pulmonary air-space shadowing on chest X-ray, without clinical signs of heart failure (Bernard et al, 1994). It has a heterogeneous aetiology with wide-ranging pulmonary and extra-pulmonary causes.
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Sevoflurane is used for inhalational induction of anaesthesia because of its pleasant odour and quick onset. However, its use for maintenance of anaesthesia in children has been questioned because of the risk of emergence delirium. Emergence delirium is defined by Sikich and Lerman (2004) as a disturbance in awareness of, and attention to, the environment with disorientation and perceptual alterations including hypersensitivity to stimuli and hyperactive motor behaviour in the immediate post-anaesthesia period. Its incidence is between 10 and 80% following general anaesthesia, and it has the potential to cause injury to the child or care provider, may cause intravenous lines or drains to become dislodged, often requires additional nursing support and delays recovery time (Vlajkovic and Sindjelic, 2007).
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This article discusses an elderly woman presenting with haematemesis and chest pain who underwent urgent oesophago-gastroduodenoscopy. This revealed a large dissecting intramural oesophageal haematoma, initially mistaken for a varix. ⋯ Misdiagnosis of the chest pain as cardiac ischaemia may have an adverse outcome if antiplatelet or anticoagulation therapy is commenced. Follow up endoscopy a week later showed complete resolution of the lesion leaving a linear mucosal defect.