The American journal of emergency medicine
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Review Case Reports
Diagnosis, complications, and treatment of dentoskeletal malocclusion.
The frequency of correctable malocclusion makes it imperative that the condition be diagnosed and referred for appropriate treatment. A complete dentofacial examination, which assesses facial symmetry and the dentition in the transverse, sagittal, and centric relations, is appropriate. ⋯ A combination of orthodontic treatment and orthognathic surgery will correct the dentoskeletal malocclusion and prevent any long-term complications. The purpose of this case report is to describe a patient with severe dentoskeletal malocclusion who benefitted from appropriate orthodontic treatment and orthognathic surgery.
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Review Case Reports
Ceramic lead glaze ingestions in nursing home residents with dementia.
Three cases of acute lead ceramic glaze ingestions that occurred in elderly patients during art therapy classes in nursing homes are reported. Initial blood lead levels were 109 micrograms/dL (5.23 mumol/L), 259 micrograms/dL (10.43 mumol/L), and 85 micrograms/dL (4.08 mumol/L), respectively, and all patients underwent chelation therapy. ⋯ Ceramic lead glaze ingestions among institutionalized patients may be more common than generally appreciated and occasionally are associated with significant morbidity or, rarely, mortality. Simple preventive measures could eliminate the majority of such occurrences.
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Multicenter Study
Bupropion overdose: a 3-year multi-center retrospective analysis.
Bupropion (Wellbutrin; Burroughs Welcome Co, Research Triangle Park, NC) is a unique monocyclic antidepressant about which there is limited overdose information. A retrospective analysis of all bupropion ingestions reported to five regional poison control centers from 1989 through 1991 was conducted. There were 58 cases of bupropion ingestion and nine cases of combined bupropion and benzodiazepine ingestion. ⋯ Five cases of pure bupropion overdose had electrolytes reported. Serum potassium ranged from 2.6 to 4.2 mEq/L (mean, 3.3 mEq/L). In overdose, bupropion seems to lack major cardiovascular toxicity; however, it does manifest significant neurological toxicity.
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Because the benefits from thrombolytic therapy in acute myocardial infarction (AMI) are time dependent, multiple strategies have been devised to speed therapy. This study sought to determine whether hospital-based nurse and paramedic advanced life support (ALS) providers could be trained to independently evaluate (sight read) a prehospital 12-lead electrocardiogram (ECG) for the presence of AMI as part of a protocol designed to speed in-hospital administration of thrombolytic agents. Providers were required to determine on the basis of a protocol (1) whether or not AMI was present, and (2) whether or not thrombolytic therapy was indicated. ⋯ Fourteen patients (9%) received thrombolytic therapy. In-hospital times to administration of thrombolytic therapy decreased to an average of 22 +/- 13.8 minutes in the studied group compared with a historical control group average of 51 +/- 50 minutes. It is concluded that hospital-based paramedics and nurses can successfully be taught to evaluate (ie, sight read) a prehospital ECG for the presence of AMI with accuracy.(ABSTRACT TRUNCATED AT 250 WORDS)