The American journal of emergency medicine
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Severe dermatologic and mucosal adverse reactions to oseltamivir are rare. To date, only two other case reports have described mucosal changes secondary to oseltamivir, but both cases were associated with concomitant skin changes. We report a case of a previously healthy 18-year-old-male who developed oral-only erythema multiforme after being treated with oseltamivir for influenza B. Given the frequency of which oseltamivir is prescribed, we highlight the importance of recognizing this uncommon but serious adverse reaction.
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To investigate the holistic characteristics of patients administered or prescribed opioids to treat pain in the emergency department (ED). ⋯ Despite increasing awareness of potential implicit bias in managing pain in the ED, racial disparities in OAP still existed. More education and training on implicit bias would help with reduce the disparities. Also, our study result indicated that non-clinical factors may play a role in emergency physicians' decision making in OAP. Increased recognition of the variation and systemic efforts to address factors affecting the variability are needed.
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Cardiac tamponade is a rare but possibly fatal complication of blunt thoracic trauma complicated by a sternal fracture. A delayed presentation of cardiac tamponade days or weeks after initial trauma has been described in a few cases. ⋯ This case describes a direct mechanical perforation of the right ventricle, caused by a displaced sternal fracture, presenting 5 days after initial trauma. To our knowledge, this mechanism of late cardiac tamponade has not been described in recent literature.
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Observational Study
Prospective study of haloperidol plus lorazepam versus droperidol plus midazolam for the treatment of acute agitation in the emergency department.
The objective of this study was to compare the combination of intramuscular (IM) droperidol/midazolam to haloperidol/lorazepam regarding time to sedation in patients with acute undifferentiated agitation in the emergency department (ED). ⋯ Intramuscular droperidol/midazolam was superior to intramuscular haloperidol/lorazepam in achieving adequate sedation at 10 min. Patients in the droperidol/midazolam arm may be more likely to receive oxygen supplementation than those in the haloperidol/lorazepam arm.
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The outcomes of large-volume IVF administration to septic shock patients with comorbid congestive heart failure (CHF) and/or end-stage renal disease (ESRD) are uncertain and widely debated in the existing literature. Despite this uncertainty, CMS continues to recommend that 30 ml/kg of an intravenous crystalloid solution be administered to patients in septic shock starting within 3 h of presentation. We performed a systematic review and meta-analysis to assess the relationship between adherence to this guideline and outcomes among patients whose underlying comorbidities present a risk of fluid overload. ⋯ Among septic shock patients with CHF and/or ESRD, administration of greater than or equal to 30 ml/kg IVF was associated with a non-significant increase in odds of mortality. All other outcomes measured were found to be non-significant, although there was a trend toward better outcomes among patients in the restricted-volume compared to the standard-volume IVF groups. Since this meta-analysis only included five observational studies, more studies are needed to guide an optimal volume and rate of fluid administration in this patient population.