The American journal of emergency medicine
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Randomized Controlled Trial Clinical Trial
Efficacy of superactivated charcoal administered late (3 hours) after acetaminophen overdose.
The purpose of this study was to investigate the effect of superactivated charcoal (SAC) given late after a drug overdose. Acetaminophen was chosen as our overdose drug because it has relatively few side effects, serum levels are easily attainable and measurable, and it is generally a common drug overdose. Forty-six healthy adult volunteers participated in this randomized, controlled study. ⋯ Serum acetaminophen levels were measured at 4 and 7 hours after the initial acetaminophen administration. There were significantly lower uncorrected and corrected acetaminophen levels in the SAC group compared with the control group at both 4 and 7 hours after ingesting acetaminophen. This randomized human experimental design trial demonstrates some detoxification benefit in administering superactivated charcoal 3 hours after an overdose.
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Randomized Controlled Trial Comparative Study Clinical Trial
Calming versus sedative effects of intramuscular olanzapine in agitated patients.
Distinct calming rather than nonspecific sedation is desirable for the treatment of acute agitation. In 3 double-blind studies, acutely agitated patients with schizophrenia (N = 311), bipolar mania (N = 201), or dementia (N = 206) were treated with intramuscular (1-3 injections/24 hrs) olanzapine (2.5-10.0 mg), haloperidol (7.5 mg), lorazepam (2.0 mg), or placebo. The Agitation-Calmness Evaluation Scale (ACES; Eli Lilly and Co.) and treatment-emergent adverse events assessed sedation. ⋯ Excluding asleep patients, agitation remained significantly more reduced with olanzapine than placebo (P <.05). The incidences of adverse events indicative of sedation were not significantly different with olanzapine versus comparators. For the treatment of acute agitation associated with schizophrenia, bipolar mania, or dementia, intramuscular olanzapine-treated patients experienced no more sedation than haloperidol- or lorazepam-treated patients and experienced distinct calming rather than nonspecific sedation.
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Review
A novel use of the endocavity (transvaginal) ultrasound probe: central venous access in the ED.
Use of ultrasound (US) to obtain intravenous access is usually accomplished with a 7.5-MHz linear US probe. This paper describes the use of an endocavity US probe to obtain vascular access. Since both probes use US of the same megahertz values, the picture quality with the two is no different. Because the equipment used for each type of probe costs thousands of dollars, the economic value of having to purchase one less probe may be significant.
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Case Reports
Diphenhydramine-induced wide complex dysrhythmia responds to treatment with sodium bicarbonate.
Diphenhydramine, a common ingredient in over-the-counter medications, is often taken in overdose. Toxicity is usually limited to anticholinergic symptoms. ⋯ Although it would be expected that, like other type IA toxicities, diphenhydramine-induced cardiotoxicity could be responsive to hypertonic sodium bicarbonate, this finding is largely unappreciated. We describe 3 cases of diphenhydramine-induced cardiac toxicity that were responsive to bicarbonate.
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It has been shown that thrombolytic therapy can improve clinical outcome in some patients with acute cerebral ischemia. These patients have been reported to be characterized by certain clinical and imaging findings, mainly with non-contrast enhanced computed tomography (CT). Our purpose in this study was to find out whether CT angiography (CTA) information about the status of the cerebral vessels is helpful in the selection of patients who may benefit the most from thrombolytic therapy for acvte cerebral ischemia. ⋯ CTA can provide important information before the initiation of thrombolytic therapy. Identification both of the occluded vessel and of an intracranial aneurysm is feasible with the use of CTA, which is particularly important if the intracranial aneurysm is a potential contraindication to thrombolytic therapy. Occlusion of a secondary branch of the MCA and internal carotid artery occlusion are valuable prognostic predictors.