JACEP
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Thirty-two cases of drug-induced dystonic reaction were treated by the author with diphenhydramine or benztropine mesylate, intramuscularly or intravenously, in a prospective, nonrandomized fashion. Recovery time with the two drugs was compared. ⋯ The commonest offensive agent in this case series was haloperidol. The most common dystonic reactions seen were buccolingual and torticollic.
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Parasympathetic tone may be high during ventricular asystole because of reflex vagal stimulation from a number of sources. Eight patients in cardiac arrest were treated with cardiopulmonary resuscitation. All eight patients had ventricular asystole as the initial rhythm or as the result of defibrillation. ⋯ In all eight cases a regular rhythm (sinus in seven, idioventricular in one) appeared within 30 seconds of administration of the last dose of atropine (1 mg to 2 mg IV). Five patients (62.5%) lived 12 hours, three (37.5%) were discharged from the hospital. These results suggest that atropine may be of value in the treatment of ventricular asystole.
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Two patients with injuries to the ankle sustained by rotational trauma complained only of pain in the ankle. Careful examination revealed tenderness over the proximal fibula. ⋯ The Maisonneuve fracture is produced by diastasis - a separation of bones resulting from rupture of ligaments around the ankle. According to classification of fibula injuries by mechanism of injury, the Maisonneuve fracture is due to external rotation of the foot relative to the tibia but it is not clear whether the foot is in pronation or supination or moves during injury.
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Pneumopericardium and pneumomediastinum following closed chest injury are rare findings, especially when symptoms are delayed for several days and are not associated with other related traumatic entities. A case is presented of a 14-year-old boy who developed symptoms of precordial chest pains and splinting two days after sustaining a direct blow to his anterior chest wall. ⋯ The diagnosis was relatively simple, using only thorough physical examination and radiographic technique. This complication should be considered in the differential diagnosis of sudden onset of cardiorespiratory conditions following trauma.