The American journal of emergency medicine
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Comparative Study
Comparison of push-dose phenylephrine and epinephrine in the emergency department.
There is limited evidence to support the efficacy and safety of push-dose vasopressor (PDP) use outside of the operating room (OR). Specifically, there are few head-to-head comparisons of different PDP in these settings. The purpose of this study was to compare the efficacy and safety of push-dose phenylephrine (PDP-PE) and epinephrine (PDP-E) in the Emergency Department (ED). ⋯ PDP-E provided a greater increase in SBP compared to PDP-PE. However, dosing errors occurred more frequently in those receiving PDP-E. Larger head-to-head studies are necessary to further evaluate the efficacy and safety of PDP-E and PDP-PE.
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The incidence of anticholinergic syndrome due to second generation antihistamines is infrequently reported. Largely due to their decreased affinity for central nervous system (CNS) receptors, second generation antihistamines are rarely associated with anticholinergic symptoms, though toxicity is still possible particularly when taken in excess. We report a case of a six year old boy who presented with agitation, hallucinations, fixed and dilated pupils, tachycardia, and hyperthermia consistent with anticholinergic toxicity several hours after accidental overdose of a second generation antihistamine, cetirizine. Early identification of this rare phenomenon is important not only for appropriate emergency management but also for avoidance of potentially invasive and unnecessary tests which may further increase patient morbidity.
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Myocardial bridging (MB) is a phenomenon that occurs when coronary arteries course through myocardial tissue rather than, as is normal, on the surface of the myocardium. Although often asymptomatic, contraction of the myocardium in the presence of a myocardial bridge can sometimes occlude the lumen of coronary arteries that penetrate the myocardium, resulting in symptoms, signs, and electrocardiographic changes indistinguishable from those associated with acute coronary syndromes (ACS) caused by intraluminal narrowing of coronary arteries or coronary artery plaque rupture. In this monograph, we present the case of a 45-year-old man who presented to the emergency department with typical chest pain accompanied by electrocardiographic changes consistent with acute occlusion of the left anterior descending artery. ⋯ There was no evidence of static coronary artery occlusion. Myocardial bridging is typically managed medically when symptomatic, although refractory cases may ultimately require invasive or surgical intervention. Given that emergency physicians are frequently the first providers to evaluate patients with acute coronary syndromes, myocardial bridging as an etiology for ACS is a clinical entity of which emergency physicians should be aware.
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Observational Study
Traumatic brain injury and intraparenchymal hemorrhage progression: Blood pressure variability matters.
Blood pressure variability (BPV) has been shown to correlate with intraparenchymal hematoma progression (HP) and worse outcomes in patients with spontaneous intracerebral hemorrhage (sICH). However, this association has not been elucidated in patients with traumatic intraparenchymal hemorrhage or contusion (tIPH). We hypothesized that 24 h-BPV from time of admission is associated with hemorrhagic progression of contusion or intraparenchymal hemorrhage (HPC), and worse outcomes in patients with tIPH. ⋯ SBPCV was significantly associated with HP among patients who required EVD. Additionally, increased SBPmax-min was associated with an increase in mortality. Clinicians should be cautious with patients' blood pressure until further studies confirm these observations.