J Emerg Med
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Review Case Reports
Acute airway compromise after brief exposure to a Dieffenbachia plant.
Dieffenbachia is a common domestic plant. Oral contact with the plant usually is associated with minimal consequences. However, chewing on the stem or the leaf of the Dieffenbachia can result in painful oropharyngeal edema and the inability to speak or handle secretions. ⋯ The exact mechanism of edema is not known; therefore, methods of treatment are variable. We recommend caution when presented with a patient exposed to Dieffenbachia. Even the patient who initially seems stable may have an airway that will quickly deteriorate.
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Gatherings of large numbers of people at concerts, sporting events, and other occasions lead to an assembled population with a potential for a wide variety of illnesses and injuries. The collection of large numbers of people in a single location has led some authors to recommend the placement of resuscitation equipment or other medical services in close proximity to these activities. These recommendations not withstanding, data on the frequency of critical illness at mass gatherings (a group exceeding 1000 persons) are difficult to ascertain. ⋯ Of those referred to the ED, 50 (38.7%) patients were transported by ambulance and only 17.4% were admitted to telemetry, with none admitted to an ICU. It is concluded that critical illness at mass gatherings is infrequent, as seen in this study, with very few being admitted to telemetry and none to an ICU. Careful consideration of cost-benefit should occur when determining allocation of resources for these activities.
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The purpose of this study was to measure, in a population of experienced state-certified paramedics, the decline of Pediatric Advanced Life Support (PALS) course concepts during the 2-year recertification cycle recommended by the American Heart Association. The PALS course contains a written examination designed to measure understanding of course concepts. To successfully complete the course, a PALS course participant must achieve a minimum grade of 84% on this test. ⋯ The average retest score was 16 points lower than the original test score. The original test score did not reliably predict a passing grade on the retest. We conclude that the average decline of PALS course principles is such that a 2-year retraining schedule is appropriate for prehospital personnel caring for an average of three to four pediatric patients per month.
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The use of B-type natriuretic peptide to diagnose congestive heart failure is becoming more frequent and widespread. We report five patients recently seen at our hospital who were diagnosed with pulmonary embolism and noted to have elevated B-type natriuretic peptide levels. We caution that elevations of B-type natriuretic peptide may in some patients have the potential to mislead clinicians if the diagnosis of pulmonary embolism is not considered.
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The PFAPA (Periodic Fever, Aphthous stomatitis, Pharyngitis, Adenitidis) syndrome is characterized by periodic fever, adenitis, pharyngitis, and aphthous stomatitis. Herein, we present a Turkish child with PFAPA syndrome mimicking familial Mediterranean fever because of a rare presentation. A 9-year-old boy was admitted with recurrent fever, aphthous stomatitis, sore throat, headache, and general body pains, lasting 2 to 3 days since 3.5 years of age. ⋯ At this writing the patient is in the 12th month of follow-up, and there have been no symptoms after the second attack. In conclusion, our patient shows that PFAPA syndrome can be confused with familial Mediterranean fever. We also would like to emphasize that the typical PFAPA syndrome can be easily diagnosed by detailed history-taking and physical findings.