Chest
-
Dependence on crisis-oriented care rather than continuous ambulatory care for asthma is thought to contribute to asthma morbidity and mortality. We contrasted the characteristics of patients who depend on emergency department (ED) care for the management of their asthma exacerbations to the characteristics of patients employing self-management plans in an ambulatory setting. ⋯ We conclude that a subgroup of asthmatics depends primarily on crisis-oriented care for the management of asthma. These patients are more likely to have lower income, to live alone, and to have resided at their current address for less time than patients seeking less urgent ambulatory care. Moreover, such patients are less knowledgeable about asthma and its management and are less likely to have a predetermined crisis plan.
-
The continuous infusion of the loop diuretic, bumetanide, has been shown to be effective in the treatment of severe refractory edema. Musculoskeletal symptoms have been reported with bumetanide following both oral and intermittent i.v. bolus therapy. It has been suggested that these adverse effects do not occur with continuous infusion. We describe, however, a series of patients with heart failure who developed severe disabling musculoskeletal symptoms during the continuous infusion of humetanide. ⋯ The continuous i.v. infusion of the loop diuretic, bumetanide, may result in severe, disabling musculoskeletal symptoms. The reaction appears to be dose related, without specific risk factors, and is reversible on discontinuation of the infusion. Patients who experience this reaction may be successfully diuresed with equivalent doses of a furosemide infusion.