J Emerg Med
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Acute respiratory failure (ARF) is a common cause of presentation to the Emergency Department (ED). High flow nasal cannula (HFNC) has been introduced as an alternative way to administer oxygen. ⋯ We did not find any benefit of HFNC compared with COT and NIV in terms of intubation requirement, treatment failure, hospitalization, and mortality; COT was better tolerated.
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Observational Study
Epidemiology of Severe Acute Diarrhea in Patients Requiring Hospital Admission.
Information on the epidemiology and susceptibility patterns of main pathogens causing severe acute diarrhea may help to reduce inappropriate antimicrobial use in emergency departments. ⋯ The FilmArray Gastrointestinal Panel system provides fast and reliable results and could be useful to select the most appropriate antimicrobial based on local susceptibilities until the results of the cultures are available.
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Seizures count to critical situations emergency medical systems (EMS) are confronted with. ⋯ The treatment success of the MTAS-EMS is high. However, in adults the single dose of i.v. diazepam is as successful as the completely used MTAS-EMS and seems to be superior to the single dose iv and nasal midazolam.
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Despite multiple treatment options, antihypertensive overdose remains a cause of significant morbidity and mortality. Intravenous angiotensin II (AG II) is approved for use in vasodilatory shock. We describe 2 cases of refractory shock from antihypertensive overdose that were successfully treated using AG II. ⋯ A 24-year-old female presented after an overdose of multiple antihypertensive medications, including an angiotensin converting enzyme inhibitor (ACEI). She developed hypotension that was refractory to norepinephrine, epinephrine, and vasopressin, with a mean arterial pressure (MAP) of 57 mm Hg 9 h after emergency department arrival. Fifteen minutes after starting AG II at 10 ng/kg/min, her heart rate and MAP rose by 7 beats/min and 12 mm Hg, respectively. Her hemodynamic parameters continued to improve thereafter. She developed acute kidney injury, which resolved prior to discharge. The second patient, a 65-year-old male, presented after an overdose of multiple antihypertensive medications, including an ACEI. Despite norepinephrine, epinephrine, and hyperinsulinemia-euglycemia, he remained bradycardic and hypotensive, with a heart rate of 47 beats/min and MAP of 59 mm Hg. Thirty minutes after starting AG II at 10 ng/kg/min, his heart rate was 61 beats/min and MAP was 66 mm Hg. He recovered without apparent sequelae. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Antihypertensive overdose can lead to shock refractory to catecholamine and vasopressin therapy. Our experience suggests that AG II is efficacious in antihypertensive overdose and may be particularly efficacious in instances of ACEI overdose. However, further study is required to confirm the appropriate indication(s).
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Gastrointestinal complications secondary to fish bone ingestion are rare, however important to recognize in timely manner to prevent morbidity and mortality. Diagnosis is often challenging in setting of non-specific and variable symptoms and lack of history of fish bone ingestion. Diagnostic imaging particularly computed tomography is crucial for diagnosis. ⋯ Emergency physician should be aware of this entity to identify it and triage the patients in timely manner. We describe here cases of sub-capsular liver abscess and acute cholecystitis caused by fish bone ingestion. The fish bone as a cause of these complication was initially missed in emergency.