Emergency medicine journal : EMJ
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A 76-year-old woman being treated with sodium valproate for bipolar depression presented with a 4 day history of acute confusion and tremulousness. She had apnoeic episodes, reduced conscious level and generalised myoclonic movements. ⋯ Administration of naloxone 0.8 mg led to rapid clinical improvement. Naloxone may be useful in reversing the features of chronic valproate toxicity.
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Case Reports
Acute respiratory distress syndrome induced by oral methadone managed with non-invasive ventilation.
Non-cardiogenic pulmonary oedema is an uncommon complication of both methadone and heroin overdose, often requiring a period of invasive ventilation due to its severity. We report the successful, early use of non-invasive ventilation in the management of non-cardiogenic pulmonary oedema secondary to a non-fatal overdose of oral methadone.
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A case is presented of cardiac arrhythmia associated with varicella zoster infection, affecting a 34-year-old man. The patient presented with episodes of seizure-like activity, which were subsequently shown to be caused by ventricular fibrillation. The literature regarding this unusual complication of varicella zoster infection is discussed, as it affects both children and adults. Physicians who may face this condition, in accident and emergency, acute medicine, critical care medicine and infectious diseases, should all be aware of this serious complication.
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A review was performed looking at the first 100 intubation procedures performed or solely supervised by one emergency medicine trainee. Over the 5 year period during which the procedures were performed the author performed 93 and supervised 7 procedures. There were 90 rapid sequence intubation procedures and 10 intubations without drugs. ⋯ This study suggests that as a trainee gains experience in performing intubation procedures, the nature of the complications arising changes. Initial complications involved misplacement of the tube, whereas later complications involved not obtaining an adequate view, latterly in increasingly difficult airways. Truly difficult airways are not common and may not be experienced until much later in a trainee's career.
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To identify the content of the national postgraduate pharmacology curriculum for trainees in UK emergency medicine. ⋯ Application of a national consensus methodology allows determination of curricular content in pharmacology as part of the development of a robust College educational portfolio.