J Emerg Med
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Randomized Controlled Trial Clinical Trial
The GI Cocktail is no more effective than plain liquid antacid: a randomized, double blind clinical trial.
The "GI Cocktail" is a mixture of medications often given in the Emergency Department (ED) for dyspepsia symptoms. Several combinations are used, but the most effective has not yet been determined. This study compared three combinations commonly given for dyspepsia. ⋯ There was no statistically significant difference in pain relief between the three groups on univariate analysis or multivariable regression. In conclusion, the addition of Donnatal or Donnatal + lidocaine to an antacid did not relieve dyspepsia better than plain antacid. The "GI Cocktail" concoction may not be necessary.
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Review Case Reports
Electrocardiographic manifestations: ventricular tachycardia.
Ventricular tachycardia is a serious rhythm disturbance that originates from any part of the myocardium or conduction system below the atrioventricular node. Ventricular tachycardia (VT) presents with a wide QRS complex and a rate greater than 120 beats/min. Ventricular tachycardia is frequently encountered as a complication of coronary artery disease or cardiomyopathy; furthermore, VT is also seen in patients with medication adverse effect or electrolyte disturbance. ⋯ As is true in most Emergency Department presentations, the Emergency Physician must approach the dysrhythmic patient from an undifferentiated perspective, in this instance, the wide complex tachycardia (WCT) scenario. The electrocardiographic differential diagnosis of WCT classically includes VT and supraventricular tachycardia with aberrant intra-ventricular conduction. This article will review the electrocardiographic presentations encountered in patients with ventricular tachycardia.
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The study objective was to determine if Emergency Department (ED) patients experience breaches of privacy and confidentiality during their ED stay and to determine if the type of room in which the patient is placed affects privacy. We surveyed a convenience sample of ED patients at the conclusion of their ED stay regarding their privacy and confidentiality. Overall, 36% of patients overheard conversations with similar frequencies in walled and curtained rooms. ⋯ Patients felt more comfortable giving their history and having physical examinations performed in walled vs. curtained rooms. Inappropriate or unprofessional comments by staff were heard by 1.6% of patients. Health care providers in the ED need to be aware of breaches in confidentiality and privacy, as our patients deserve respect of their privacy and confidentiality during their ED visit.
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Clonidine and the imidazolines, commonly found in topical ophthalmic and nasal decongestants, are chemically related drugs that have been responsible for many pediatric poisonings. These medications can cause significant morbidity in small doses. A review of the available literature reveals that young children have exhibited severe signs and symptoms after ingesting as little as one to two clonidine tablets or 2.5 ml of a topical imidazoline product. ⋯ Signs and symptoms develop rapidly, within 4-6 h. Care is supportive. Death is rare, but many poisoned patients require monitoring in an intensive care setting.
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The diagnosis of ethylene glycol poisoning is based on nonspecific clinical symptoms and signs and indirect and direct laboratory measurement. Few institutions have timely access to direct measurement of ethylene glycol. ⋯ These cases demonstrate the need to recognize the false elevation of lactate in some chemistry analyzers due to the interference of glycolic acid, a metabolite of ethylene glycol. Using the "lactate gap" in comparing the measurement of lactate with two commonly used chemical analyzers aids in differentiating ethylene glycol poisoning from lactic acidosis.