J Emerg Med
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Insulin glargine (Lantus, Aventis Pharmaceuticals, Bridgewater, NJ) is a long-acting once-daily dosed form of insulin intended to maintain a constant baseline insulin level. As a relatively new medication, there is limited experience in overdoses of Lantus. ⋯ The patient was managed with oral intake, intravenous dextrose bolus, peripheral 10% dextrose solution, 25% dextrose sliding scale via central line, and psychiatry evaluation for suicide attempt. Other potential treatments discussed for possible use with long-acting insulin overdoses include incision and drainage of the injection site, glucagon, and octreotide.
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We present a case of a 4-year-old previously healthy child who had a possible first-time seizure at home, and upon a second Emergency Department evaluation was found to have gross cerebellar ataxia suggestive of acute stroke. Initial computed tomography scan and metabolic work-up were unrevealing. Subsequent neuroimaging demonstrated stroke in the left medulla and cerebellum secondary to left vertebral artery dissection. ⋯ Symptoms of posterior circulation ischemia resulting from vertebral artery dissection may include vertigo, vomiting, ataxia, dysarthria, and seizure. Willingness to utilize newer, non-invasive imaging modalities may lead to earlier recognition of cervical artery dissection when patients have prodromal symptoms or episodes of transient ischemia. Vertebral artery dissection should be included in the differential diagnosis when evaluating children with first time seizure, headache, or neck pain.
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The evaluation of first trimester vaginal bleeding or pelvic pain is an important task for the emergency physician. The early identification of an ectopic pregnancy can help prevent significant morbidity and mortality for patients seeking emergency care. ⋯ We present the case of a patient found to have a cervical ectopic pregnancy. A discussion of the diagnosis and management, as well as the findings on bedside sonogram are presented.
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It is common to evaluate pediatric patients with suspected malfunction of intraventricular shunts (VS) with cranial computed tomography (CT) as well as radiographs. Yet, the clinical yield of these studies is not well defined. We conducted a study to determine if radiographs of VS add useful clinical data in the evaluation of shunt malfunctions. ⋯ The 2 remaining children had radiographs demonstrating abnormality of their VS. Both children, however, had a classic clinical presentation of shunt malfunction. In this series, plain radiography in patients with suspected shunt malfunction, looking for breakage or discontinuity of the shunt, may represent unnecessary ionizing radiation exposure and expense.