The American journal of emergency medicine
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Case Reports
Use of fomepizole, n-acetylcysteine, and hemodialysis for massive acetaminophen overdose.
Acetaminophen poisoning is the leading cause of liver transplantation within the United States, accounting for nearly 56,000 emergency department patient visits each year. Although n-acetylcysteine is commonly successful in preventing acetaminophen toxicity when given in a timely manner, reports do exist demonstrating n-acetylcysteine therapy failure, commonly in the setting of a massive ingestion. We present the use of a novel antidote cocktail of n-acetylcysteine, fomepizole, and hemodialysis to treat a massive acetaminophen ingestion. ⋯ The patient was diagnosed with severe acetaminophen poisoning and was promptly administered n-acetylcysteine. Due to the severity of the patient's ingestion and the concern for additional coingestants, the patient was also given fomepizole therapy and later underwent hemodialysis for more rapid toxin clearance. After a four-day stay in the hospital the patient was discharged to a mental-health facility with no signs of systemic injury.
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Emergency physicians frequently treat hyperemesis gravidarum and should be aware of possible complications. Wernicke encephalopathy secondary to thiamine deficiency should be considered in the differential diagnosis of acute encephalopathy in pregnant women. A seventeen-week pregnant 27-year-old woman presented to the Emergency Department with nausea, emesis, and right upper quadrant abdominal pain. ⋯ Emergency physicians frequently treat hyperemesis gravidarum. Nutritional status should be evaluated in patients who are unable to take neonatal vitamins. Awareness should exist of possible complications, including Wernicke encephalopathy secondary to thiamine deficiency.
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Pneumonia is a known complication following rib fractures. This study was undertaken to identify clinical and demographic factors associated with the development of pneumonia among trauma patients with rib fractures. ⋯ Risk factors for the development of pneumonia following rib fractures include male gender, higher number of rib fractures, alcohol consumption, and higher rates of intravenous fluid administration during the initial 24 h following trauma.