J Emerg Med
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Bilateral vocal cord paralysis can produce severe airway obstruction, leading to acute respiratory failure. Discriminating the pathology of the upper airway from chronic obstructive diseases of the lower airways often presents a challenge for clinicians in the Emergency Department. ⋯ Vocal cord paralysis is a rare and often neglected condition, contributing to repeated episodes of acute respiratory failure. Flow-volume loop is a useful tool when symptoms are suggestive of upper airway obstruction.
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Prescription opioid products are often formulated with acetaminophen, but the pharmacokinetics of nasally administered acetaminophen are poorly characterized. We report a case of a potentially toxic acetaminophen concentration after nasal insufflation of oxycodone/acetaminophen tablets. ⋯ The pharmacokinetics of nasally administered acetaminophen have not been well studied, yet there is potential for significant exposure with prescription opioid abuse. Clinicians should be vigilant in evaluating patients for toxicity due to adjunct medications formulated in narcotic pain preparations used by routes other than ingestion.
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Case Reports
Postobstructive Pulmonary Edema in a 40-Year-Old Man after Suffocation by a Swimming Pool Cover.
Postobstructive pulmonary edema (POPE) is a form of sudden onset, noncardiogenic pulmonary edema that can occur after the relief of an upper airway obstruction. ⋯ Emergency physicians should consider the diagnosis of POPE in a symptomatic patient if there is evidence of pulmonary edema immediately after a history of hanging, suffocation, strangulation, choking, naloxone administration, or other forms of upper airway obstruction. Rapid initiation of NIPPV with or without diuretics, steroids, or fluid restriction can lead to symptom resolution within 24 to 48 h.
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Inadequate treatment of painful conditions in children is a significant and complex problem. The wide range of cognitive abilities associated with a child's age is a particular challenge for providers treating children with painful conditions. ⋯ Young patient age is associated with different analgesic prescription patterns in children treated in the ED for a long bone fracture.
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As the specialty of Emergency Medicine (EM) develops around the world, it has become common for practitioners from countries with mature EM systems to assist those in regions with developing systems. One effective and frequently used model is "train the trainers," in which a group of consultant teachers instructs a cadre of clinicians in the host region to then become the future teachers of EM in that area. This model has the advantage of overcoming cultural barriers to instruction and can lead to providing a lasting training infrastructure in the region. A key to a successful program is the use of effective and culturally appropriate teaching and feedback skills. ⋯ Applying the described teaching and evaluation skills with modifications based on local culture will help empower newly trained teachers who will contribute in turn to the longevity of EM in the region and set a high teaching standard that will benefit generations of future colleagues.