Emergency medicine journal : EMJ
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Case Reports
Allergy evaluation after emergency treatment: anaphylaxis to the over-the-counter medication clobutinol.
Anaphylaxis is traditionally diagnosed and treated as an acute emergency but should be always followed by a search for specific triggers, resulting in avoidance strategies. This case report highlights the relevance of a detailed evaluation after anaphylaxis for diagnosis of a rare but potentially life-threatening allergy. Considering the high frequency of clobutinol application, IgE-mediated allergic hypersensitivity seems extremely rare and has to be distinguished from infection-associated urticaria and angioedema as well as non-specific summation effects. Accidental re-exposure has to be strictly avoided and therefore after identification of clobutinol as the anaphylaxis trigger, the patient received detailed allergy documents including international non-proprietary and trade names of the culprit drug.
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Patients with mechanical heart valves require anticoagulation within carefully controlled ranges to prevent valve thrombosis, a life-threatening condition. The majority of doctors will be required to manage anticoagulation, often on a temporary basis such as during elective procedures. As long-term anticoagulation management moves away from specialised hospital clinics, there needs to be widespread awareness of the complications of sub-therapeutic international normalised ratios (INRs).
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Case Reports
Case of the month: Honey I glued the kids: tissue adhesives are not the same as "superglue".
A case of a father who treated his child's facial laceration with the home supply of "superglue" having been previously misinformed that superglue is used to treat lacerations is presented. The differences between tissue adhesive and superglue are described and suggest that emergency staff should be careful to avoid using the term "superglue" when using tissue adhesives.
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Blood cultures are routinely used to investigate suspected sepsis in the emergency department despite several studies demonstrating their limited influence on patient management. ⋯ Blood cultures taken in our emergency department rarely yield bacterial growth and over 2 years, only four seemed to directly influence patient management. Better guidelines are required for targeted use of blood cultures in the emergency department.
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Helicopters and light (unpressurised) aircraft are used increasingly for the transport of ventilated patients. Most of these patients are ventilated through endotracheal tubes (ETTs), others through laryngeal mask airways (LMAs). The cuffs of both ETTs and LMAs inflate with increases in altitude as barometric pressure decreases (30 mbar/1000 feet). Tracheal mucosa perfusion becomes compromised at a pressure of approximately 30 cm H2O; critical perfusion pressure is 50 cm H2O. ⋯ The data for LMA cuff expansion failed to show significant correlation with altitude change. Further work is required to determine a similar rule of thumb for LMA cuff deflation.