J Emerg Med
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Core content in Emergency Medicine Residency Programs is traditionally covered in didactic sessions, despite evidence suggesting that learners do not retain a significant portion of what is taught during lectures. ⋯ When these techniques are incorporated, sessions can be effective in delivering core knowledge, contextualizing content, and explaining difficult concepts, leading to increased learning.
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Latex allergy is thought to be present in up to 6.5% of the general population, and can be much higher among those with chronic exposure. It is, however, uncommonly associated with severe anaphylactic reactions. Hair-care practices, such as the application of a hair weave, are a potential cause of latex-related anaphylaxis because the adhesives often contain natural rubber latex. ⋯ We report the first case in the emergency medicine literature of successful treatment of a patient with airway compromise secondary to hair glue exposure. This case involved a 29-year-old woman who presented to the emergency department with severe angioedema and airway compromise. The patient had recently had an adhesive substance applied to her scalp for a hair weave placement. The patient did respond initially to antihistamine and alpha-adrenergic medication, however, because the allergen could not be removed, she relapsed, was subsequently intubated, and admitted to the intensive care unit. The latex-containing hair glue was removed over a period of several hours using an oil-based hair-conditioning product. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: This unique and potentially lethal situation required innovative management. Successful resolution of this case required a high degree of cultural literacy leading to the correct diagnosis and treatment, and utilization of resources outside of the health care field. Clinicians treating patients in areas where similar hair-care practices are prevalent should be aware of this pathology, and consider similar management strategies.
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Patients suffering from heatstroke often present with electrocardiograph abnormalities, but persistent ventricular tachycardia has not been reported previously. ⋯ This case represents the first report of ventricular tachycardia occurring in a patient with heatstroke. Successful cardioversion could not be achieved until his core body temperature was lowered significantly, reinforcing the need for rapid temperature reduction that can be accomplished through noninvasive means.
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Baptisia is commonly found in residential gardens as an ornamental plant, in municipal "rain gardens" for water control, as well as in native and restored prairie habitat. Cytisine, an alkaloid with nicotinic acetylcholine receptor agonist properties, is a component of Baptisia. ⋯ Two patients poisoned after simultaneously ingesting Baptisia plant material are presented. In addition to findings of generalized nicotinic agonist toxicity, including generalized weakness and gastrointestinal symptoms, profound ataxia was present in both, consistent with recently described nicotinic subunit activity in the cerebellum. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Baptisia, a native prairie plant commonly found in restored prairie habitats and public spaces, has striking "look-alike" characteristics, in its immature state, to asparagus. As future exposures by foraging citizens will be likely, awareness of this relationship and the toxic manifestations of cytisine will be useful.