The American journal of emergency medicine
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The objective of this study was to examine the use of limited, goal-directed, two-dimensional ultrasound studies performed by emergency physicians and to assess the frequency, variety, and accuracy of their readings. A 1-year prospective study was performed by using an emergency department (ED) ultrasound machine with a 3.5-mHz mechanical oscillating sector transducer and a 5.0-mHz vaginal transducer. In a series of proctoring sessions, radiologists trained emergency physicians to do limited, goal-directed ultrasonography. ⋯ Eleven categories of ultrasound use were reported. The three studies most commonly performed were for gallbladder disease (53%), intrauterine pregnancy (28%), and abdominal aortic aneurysms (7%). Accuracy of ED gallbladder ultrasonograms for 65 patients showed a sensitivity of .86, specificity of .97, PPV of .97, and NPV of .85.(ABSTRACT TRUNCATED AT 250 WORDS)
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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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Case Reports
Reversible neurological deficits in a chronic alcohol abuser: a case report of Wernicke's encephalopathy.
The abuse of alcohol presents daily challenges for the emergency medicine physician. Wernicke's encephalopathy represents one of the metabolic complications associated with alcoholism. ⋯ Following administration of intravenous thiamine, the patient's symptoms spontaneously resolved. The pathophysiology, clinical presentation and therapy of this classic disorder are discussed.
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Psychiatric medications cause side effects in several organ systems that need emergency evaluation and treatment. Serious cardiovascular side effects include postural hypotension, cardiac conduction blockade, and SA mode dysfunction; serious neurological side effects include extrapyramidal reactions, seizures, delirium, catatonia, pseudotumor cerebri, ataxia, and glaucoma; serious genitourinary side effects include urinary retention, nephrotic syndrome, and priapism, and the serious hematological side effect of agranulocytosis. Also potentially fatal syndromes secondary to psychiatric drugs are the neuroleptic malignant syndrome, hyperandrenergic crisis, the serotonin syndrome, and lithium toxicity. Individual psychiatric drug classes most notorious for causing side effects with high morbidity and mortality are low potency neuroleptics, clozapine, tertiary tricyclics, monoamine oxidase inhibitors, and lithium.
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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.