J Emerg Med
-
There have been numerous studies performed to assess the impact of adjunctive corticosteroid therapy on the outcome of pediatric bacterial meningitis. Much of these data are conflicting, which can result in confusion regarding therapeutic efficacy. The present article will review the pathophysiology of this disease, critique the body of medical literature on this aspect of therapy, and provide guidelines for the emergency physician on the use of dexamethasone therapy for bacterial meningitis in children.
-
Pneumomediastinum is an entity with diverse underlying etiologies and variable clinical presentations. We present a case of pneumomediastinum that on initial presentation appeared to be an upper airway emergency most consistent with adult epiglottitis. The pathophysiology of pneumomediastinum involves extravasation of air through perivascular interstitial tissues. ⋯ This may cause patients with pneumomediastinum to have symptoms such as a sore throat or dysphagia. The patient we describe had such dramatic upper airway symptomatology that adult epiglottitis was the initial suspected diagnosis, and acute airway intervention was required. The various etiologies, presentations, and pathophysiology of pneumomediastinum are discussed.
-
Neuromuscular blocking agents (NMBAs) are utilized frequently in the emergency department (ED). We begin with a brief history of neuromuscular blockade, then review the indications and guidelines for its use in the emergency department setting. The relevant agents will be discussed focusing on dosage, side effects, and adverse reactions. Special attention will be paid to succinylcholine, the drug most commonly employed in the ED setting, followed by a summary of the nondepolarizing agents currently available, in particular the four shorter-acting agents that are most appropriate for administration in the ED.