The American journal of emergency medicine
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Review Case Reports
Imipramine-provoked paradoxical pheochromocytoma crisis: a case of cardiogenic shock.
The dramatic presentation of pheochromocytoma in crisis is uncommon and is classically associated with a state of hemodynamic and sympathetic hyperactivity. The case of a 35-year-old man with an occult pheochromocytoma presenting with hypotension and cardiogenic shock shortly after beginning imipramine therapy is presented. Retrospectively, there was a history of emergency department, inpatient, and outpatient evaluation of symptoms likely to be related to an occult pheochromocytoma. ⋯ Shortly after admission the patient's occult pheochromocytoma was discovered and subsequently specific therapy was initiated. The patient's symptoms resolved after surgical resection of the tumor, and he was ultimately discharged without signs of congestive heart failure. The clinical pathophysiology of cardiomyopathy secondary to pheochromocytoma, and possible mechanisms of pharmacological interactions with tricyclic antidepressants are discussed.
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In a retrospective case review of inpatient and emergency department (ED) records during a 55-month period, 155 hospitalizations for Kawasaki syndrome (KS) were identified, of which 44 were seen in the ED. In 16 cases, KS was already suspected by their private physicians and confirmed in the ED by a KS specialist. In the remaining 28, patients presented initially to the ED. ⋯ In four instances, patients were hospitalized for other reasons. In all cases in which the diagnosis of KS was not made in the ED, viral infections or sepsis were suspected. One child presented to the ED in respiratory arrest and severe bradycardia.
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Review Case Reports
Midgut volvulus: an unusual case of adolescent abdominal pain.
Rotational gut abnormalities are generally considered a disease process of the neonatal and pediatric populations. However, they may first become manifest in teenagers and adults, often with disastrous outcomes. ⋯ At surgery, he was found to have a midgut volvulus. A differential diagnosis is discussed, as well as an anatomical review and typical symptomatology associated with midgut abnormalities.
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To determine current practices regarding security measures in the emergency department (ED), a random sample of 250 hospitals with EDs was surveyed by telephone. Security issues addressed included personnel (in-house security, contract guards, or police), hours of staffing in the ED, how security is armed, whether ED doors are locked at off-hours, and whether alarm buttons, direct phone lines, a paging code, closed circuit surveillance, metal detectors, and seclusion rooms are used. This information was stratified according to hospital size, ED census, rural/suburban/urban setting, teaching/nonteaching status, and region. ⋯ Small, rural hospitals are more likely to lock the ED doors at off-hours, whereas the use of security codes does not clearly follow demographic trends. Larger hospitals in suburban and urban settings and having a teaching status are more likely to have secure/detention rooms and closed circuit surveillance. The use of alarm buttons and/or direct telephone lines varies widely, but is generally more common in larger, teaching hospitals, located in urban and suburban settings.