J Emerg Med
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Asthma is a common cause of morbidity and mortality in the United States, with over two million Emergency Department (ED) visits each year. Airway inflammation is recognized as a major component in the pathophysiology of asthma. The classic presentation of asthma is that of wheezing, cough, and dyspnea, however, the severity of airflow limitation correlates poorly with clinical signs. ⋯ Inhaled corticosteroids, leukotriene modifying drugs, and noninvasive positive pressure ventilation should be considered in patients with severe disease and in those who have responded poorly to standard therapy. Mechanical ventilation is usually well tolerated and may be lifesaving in patients with refractory asthma. Precautions are required to prevent dynamic hyperinflation during assisted ventilation.
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Opioid-mediated contraction of the distal common bile duct (CBD) may delay tracer passage during nuclear hepatobiliary imaging (NHI), mimicking pathologic obstruction. We sought to determine if opioid administration before NHI delays CBD visualization and prolongs imaging. The records of 198 Emergency Department patients who underwent NHI were reviewed (after excluding those with evidence for pathologic CBD obstruction). ⋯ Delayed imaging was performed in 77.8% of those who had received opioids and in 53.5% of those who had not (p < 0.01). The relative risk of delayed CBD visualization was 1.46 [95%CI 0.65-3.28] for meperidine, 4.18 [95%CI 2.00-8.82] for morphine, and 2.38 [95%CI 1.29-4.39] for any opioid. We conclude that opioids given before NHI are associated with delayed CBD visualization and more imaging sessions.
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Bupropion is an antidepressant and smoking cessation aid. Limited toxicological information exists for intentional and unintentional bupropion-only exposures. A retrospective review of all bupropion-only exposures reported to the Toxic Exposure Surveillance System from 1998 through 1999 was conducted. ⋯ Seizures developed in 15% of all intentional exposures. Cardiovascular disturbances were extremely uncommon after overdose. The majority of unintentional bupropion-only exposures result in minimal or no clinical toxicity; however, a significant number of intentional overdoses result in seizures.
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Case Reports
Delayed diagnosis of small bowel obstruction following laparoscopic lymph node dissection.
Laparoscopic surgical procedures are infrequently complicated by bowel herniation through unsutured trocar sites. Nevertheless, there is a risk of this complication in patients presenting with symptoms of small bowel obstruction after laparoscopy. We present a case of delayed small bowel obstruction due to a Richter's hernia, a rare type of hernia that involves incomplete protrusion of bowel wall through a surgical defect. Knowledge of this potential complication of laparoscopic procedures may prevent the significant morbidity that results from mechanical small bowel obstruction with necrosis.