European journal of emergency medicine : official journal of the European Society for Emergency Medicine
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Case Reports
Accidental intravenous administration of racemic adrenaline: two cases associated with adverse cardiac effects.
Accidental intravenous administration of racemic adrenaline (epinephrine) is a rare but potentially lethal complication. We describe a case of a 68-year-old man with chronic obstructive pulmonary disease who developed severe dyspnoea at home, and a case of an 81-year-old woman who had an allergic reaction associated with severe dyspnoea. ⋯ Previous reports of accidental intravenous administration of racemic adrenaline are also reviewed. We discuss the potential risks of using racemic adrenaline, especially in the treatment of geriatric patients, and the possibilities of reducing the risk of accidents in drug administration.
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Wound botulism is a rare infectious disease due to neurotoxin release from the anaerobic, spore-forming bacterium Clostridium botulinum that is becoming an ever more frequent complication of parenteral drug abuse in the Western world. Before the year 2000, no such cases had been reported in the UK and Ireland, but since then the number of proven and suspected cases of wound botulism occurring in parenteral drug users has increased markedly. ⋯ This is the case report of a male heroin user who presented three times to an Emergency Department in the UK before a diagnosis of wound botulism was made and treatment commenced. It is important that emergency clinicians are aware of the possibility of wound botulism in parenteral drug users that present with unusual neurological or respiratory symptomatology.
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The incidence and prevalence of imported disease within the emergency department is not known. It is known, however, that a significant number of patients attend medical practitioners after they return from travelling. If practitioners working in emergency departments are unaware of the potential for nonendemic disease in the population of patients they attend, there is a possibility that imported diseases will remain undiagnosed in the acute setting. ⋯ It appears that medical practitioners in emergency departments do not routinely establish a travel history, or consider the diagnosis of imported disease, when presented with a clinical scenario that describes a possible imported disease. Consequently, there is a high potential for imported disease to be missed in the emergency department.
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A case of paediatric aortic dissection is reported. The pathogenesis, investigation and treatment are discussed. We highlight that the history and nature of the pain should alert clinicians to this condition and that baseline investigations may be normal.