J Emerg Med
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This review assesses the role of epinephrine in cardiopulmonary resuscitation from the perspective of mechanisms of action, cardiac and cerebral effects, and use in human beings. We reviewed the literature from 1966 onward, using a Medline Search of the National Library of Medicine with the key words: "heart arrest," "resuscitation," and "epinephrine." Pertinent articles that represented original research were critically appraised by at least two authors. ⋯ Limited human data confirm the dose-dependent vasopressor response to epinephrine and the potential for improved immediate survival with higher doses. We suggest that randomized controlled human trials are needed to document the usefulness of higher doses of epinephrine in cardiopulmonary resuscitation.
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As more people travel to the oceans for sport diving and other marine related activities, the incidence of marine envenomations has risen. This article is designed to give the emergency physician an overview of varying marine envenomations, their clinical presentation, and recommended treatment. Part 1 of this article addresses general wound management and vertebrate envenomations. Part 2 will concentrate on invertebrate envenomations.
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We present a case of diltiazem overdose in which the patient ingested 4.2 grams in an apparent suicide attempt. He arrived in the emergency department two hours postingestion with a blood pressure of 60/40 torr and a heart rate of 62 beats/min in a junctional rhythm. Intervention included activated charcoal, gastric lavage, intravenous fluids, calcium (both chloride and gluconate), dopamine, and atropine with improvement in vital signs. ⋯ All eight previously published cases of diltiazem overdose, including all unpublished reports to the manufacturer, are reviewed and their management strategies examined. Successful treatment in which recovery has occurred in less than 48 hours, includes pressors, calcium, glucagon, pacing, and charcoal hemoperfusion. A strategy for emergency physicians to use when approaching this problem is suggested from the review.
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Review Case Reports
Adrenal pheochromocytoma presenting with persistent abdominal and flank pain.
Pheochromocytoma is classically associated with paroxysms of headache and hypertension. Its presentation, however, may be more varied and subtle. ⋯ A right adrenal pheochromocytoma was diagnosed and subsequently removed. The pertinent literature is discussed.
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Review Case Reports
Intussusception associated with Henoch-Schonlein purpura.
Henoch-Schonlein purpura is a clinical diagnosis, based on a presentation including rash, arthralgia/arthritis, and abdominal pain, often with renal complications. A rare complication is intussusception, presumably initiated by an edematous vasculitic leading point in the small bowel's mucosal surface. A case is described involving a 3-year-old male, with a brief review of the literature.