The American journal of emergency medicine
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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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There is little experience with overdose of the relatively new antidepressant bupropion. The case of an 18-year-old healthy adult female patient after an intentional ingestion of 9 g of bupropion is presented. Her hospital course was significant for grand mal seizures, sinus tachycardia without conduction abnormality, and complete neurological recovery. The first pure bupropion overdose in the emergency medicine literature is presented, and the literature pertinent to emergent management of this new antidepressant is reviewed.
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Review Case Reports
Rapid infusion of magnesium sulfate obviates need for intubation in status asthmaticus.
Rapid infusion of intravenous magnesium sulfate (MgSO4) was given to two young adults with impending respiratory failure caused by status asthmaticus. The infusion of 2 g of MgSO4 during a 2-minute period was associated with an immediate, dramatic reversal of their severe bronchospasm. This treatment obviated the need for intubation. ⋯ Previous reports of MgSO4 therapy for acute asthma have used slow infusion. This is the first report of rapid infusion of MgSO4 for the emergency department management of asthma. In both cases, this therapy obviated the need for endotracheal intubation and mechanical ventilation.
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Review Case Reports
Blunt pediatric laryngotracheal trauma: case reports and review of the literature.
Blunt laryngotracheal trauma can be a life-threatening event. Two cases of isolated blunt laryngotracheal trauma in pediatric patients are presented. One case involves a 12-year-old mate who suffered isolated tracheal trauma from a fall. ⋯ The other case involves a 14-year-old female who was kicked in the neck by a horse. After unsuccessful intubation attempts that completed a tracheal transection, she required an emergency cricothyrotomy and a subsequent tracheostomy. The diagnosis, differential diagnosis, associated injuries, and treatment options for blunt laryngeal trauma are reviewed.
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New research has shown that the incidence of success of replanted avulsed teeth can be greatly increased by differentially diagnosing and treating them according to the length of extraoral time and the physiological width of the apical foramen. A specific treatment regimen has been presented that will give the physician the information necessary to maximize the success of replanted avulsed teeth that may be seen.