Delaware medical journal
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Delaware medical journal · Jan 1993
Case ReportsAnaphylaxis to protamine masquerading as an insulin allergy.
This is the case of a 62-year-old man referred for the evaluation of insulin allergy. This patient had reacted to the subcutaneous injection of Novolin 70/30 (Squibb, Princeton, N. J.) and Humulin NPH (Eli Lilly, Indianapolis, Ind.). ⋯ RAST tests revealed the titers > 24 ng/ml of protamine specific IgE with 98 percent inhibition and 1163 ng/ml of protamine specific IgG with 29 percent inhibition, while levels of insulin specific antibodies were negligible. Subsequently, the patient was treated with non-protamine containing insulin preparation, Lente insulin, without further incident. This study confirms the diagnosis of Type I hypersensitivity to protamine sulfate masquerading as insulin allergy.
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Delaware medical journal · Nov 1992
The prehospital use of nebulized albuterol on patients with wheezing whose chief complaint is shortness of breath.
The use of prehospital nebulized beta-agonists has become widespread, and their safety and efficacy has been documented. Our purpose was to study their broadened use and determine their effectiveness in specific sub-sets of wheezing patients. We conducted a six and one-half month prospective study to determine the benefit of nebulized albuterol treatments on a variety of wheezing patients whose chief complaint to paramedics was shortness of breath. ⋯ Patients with both asthma and COPD did not demonstrate increased PEFR after treatment. The majority of all patients were subjectively improved after nebulized albuterol treatments. We conclude that aerosolized albuterol is safe and effective in the prehospital treatment of patients complaining of dyspnea who are wheezing.
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Massive trauma in a near-term pregnant patient challenges the emergency physician with very difficult treatment choices. We present the case of a severely traumatized pregnant female, near term, in whom the decision to proceed with a perimortem cesarean section in the Emergency Department produced a viable infant. We discuss the guidelines that are used in making such a decision and their rationale. The physiologic changes of pregnancy that may complicate maternal assessment and the effect of shock on the fetus are also discussed.
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Delaware medical journal · Sep 1992
Delaware Emergency Medical Services System: cardiac resuscitation.
The Delaware EMS system has been in existence for 20 years. Initially begun as one paramedic unit serving New Castle County, it now comprises 15 units in a statewide system. The goal of this report is to detail the EMS system's impact on prehospital cardiac resuscitation and airway management. ⋯ First responders--ambulance crews trained in basic life support (BLS). 4. Second responders--ambulance crews trained in advanced life support (ALS), paramedics. 5. Medical Control--doctors who are in radio contact with paramedics to provide medical advice.