The American journal of emergency medicine
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Kounis syndrome (KS) is an acute coronary vasospasm after exposure to an allergen due to mast cell degranulation and existing mediators. Various drugs, conditions, and environmental exposures can cause KS. We presented 2 cases, 1 of whom had taken an antiflu drug (containing paracetamol, pseudoephedrine, and dextromethorphan). ⋯ His troponin was markedly elevated. These cases showed that there seems to be no correlation with ECG and troponin levels in KS. In addition, for patients in whom KS type 1 is expected without troponin elevation, noninvasive cardiac magnetic resonance imaging study seems to be appropriate for the diagnosis of KS.
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Pulse CO-oximetry (Rad-57; Masimo Corp, Irvine, CA) has been available since 2005. To date, all published clinical studies have focused on clinical reliability and whether the device enhances case finding through screening of various populations. This study examines whether use of pulse CO-oximetry shortens the time to diagnosis and treatment of patients with carbon monoxide (CO) poisoning. ⋯ Pulse CO-oximetry is associated with more rapid diagnosis and initiation of hyperbaric oxygen therapy in CO-poisoned patients compared with laboratory CO-oximetry. The impact on clinical outcome remains to be determined.
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The aim of this study was to investigate the clinical characteristics of anaphylactic shock and the factors associated with anaphylactic shock in anaphylaxis. ⋯ Elderly anaphylactic patients with symptoms of cyanosis, syncope, and dizziness were at increased risk for the development of shock. Physicians in the ED have to be alert to the possibility of progression to shock in patients with anaphylaxis, and early recognition of anaphylactic shock is critical for adequate treatment.
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Posterior reversible encephalopathy syndrome is a clinico-neuroradiologic entity with typical symptoms and symmetric high-signal intensity lesions in the bilateral parietooccipital lobes on T2-weighted or fluid-attenuated inversion recovery magnetic resonance imaging. In this presentation, we report a case of posterior reversible encephalopathy syndrome who was admitted to our emergency department because of seizure and deterioration of consciousness. The aim of this presentation is to alert the emergency physicians about one of the hypertensive emergencies with neurologic symptoms associated with hypertension.
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In minor cases, contrast extravasation may cause pain, swelling, and localized erythema. However, in more severe cases, extensive tissue and skin necrosis, ulceration, and compartment syndrome may occur, often necessitating a surgical consultation. Hyaluronidase has been used successfully in the management of extravasated contrast media in several reports. ⋯ In a follow-up 4 hours later, marked improvement was observed. Sixteen hours after hyaluronidase treatment, the tissue had reverted to a near-normal state with no pain, erythema, swelling, or tenderness noted. Hyaluronidase successfully treated this extravasation of a large volume of iodinated contrast and appears to be a reasonable treatment option for more extensive subcutaneous contrast media extravasations.