RESUMEN
OBJECTIVE: To evaluate whether patients admitted to the hospital with oral phenytoin overdose should receive cardiac telemetry monitoring. DESIGN: Retrospective chart review over a 4-year period. SETTING: Eastern United States community teaching hospital. PATIENTS: Forty-four patients admitted with a diagnosis of oral phenytoin overdose, with a toxic serum concentration defined as a peak level higher than 20 micrograms/ml, who had electrocardiography performed both at the time of admission and after the phenytoin level had decreased below the toxic threshold. INTERVENTIONS: None. RESULTS: Chi-square, t test, and Fisher's exact tests were used for analysis. Mean peak phenytoin concentration was 36.7 +/- 12.1 micrograms/ml, with a maximum concentration of 75 micrograms/ml. Electrocardiograms recorded at the time of hospital admission in all 44 cases revealed no clinically significant abnormalities attributable to phenytoin when toxic and posttoxic states were compared. There were no circulatory complications or deaths. CONCLUSION: Patients admitted with oral phenytoin overdose with serum concentrations as high as 75 micrograms/ml did not experience any significant cardiovascular arrhythmias or complications. Patients with oral phenytoin overdose do not warrant routine admission to a telemetry bed for management of their condition.
Asunto(s)
Electrocardiografía Ambulatoria , Fenitoína/envenenamiento , Administración Oral , Adulto , Anciano , Anciano de 80 o más Años , Sobredosis de Droga , Femenino , Humanos , Masculino , Persona de Mediana Edad , Fenitoína/administración & dosificación , Estudios RetrospectivosRESUMEN
Iliopsoas abscess is a rarely encountered entity. Early diagnosis is hindered by a nonspecific clinical presentation. The resulting delays in therapy increase morbidity and mortality rates. Our recent experience with three cases of iliopsoas abscess is presented. Based on a review of the literature, diagnostic and treatment recommendations are made.
Asunto(s)
Absceso del Psoas , Adulto , Anciano , Antibacterianos , Terapia Combinada , Drenaje , Quimioterapia Combinada/uso terapéutico , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Pronóstico , Absceso del Psoas/clasificación , Absceso del Psoas/diagnóstico , Absceso del Psoas/etiología , Absceso del Psoas/terapia , Tomografía Computarizada por Rayos XRESUMEN
The authors present a case of autoimmune polyglandular syndrome, a rare inherited condition. Early recognition allows prevention of significant morbidity and mortality. A review of the literature of this multiple endocrine end organ disease is presented.
Asunto(s)
Poliendocrinopatías Autoinmunes/diagnóstico , Adulto , Diagnóstico Diferencial , Femenino , Humanos , Poliendocrinopatías Autoinmunes/etiología , Poliendocrinopatías Autoinmunes/genéticaRESUMEN
The authors present a refined triage tool to assist in the identification of patients with GI hemorrhage. Criteria include orthostasis; current, active GI hemorrhage; hemoglobin under 10 g/dl or a 3 g/dl drop from a known baseline; and history of underlying organ system dysfunction.
Asunto(s)
Hemorragia Gastrointestinal/terapia , Triaje , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Hemorragia Gastrointestinal/complicaciones , Hematemesis/etiología , Humanos , Hipotensión Ortostática/etiología , Masculino , Persona de Mediana Edad , Pronóstico , Estudios Prospectivos , Estudios RetrospectivosRESUMEN
This study shows that a critical care severity scale cannot be used to decide which patients at admission, in a community teaching hospital, should go to critical care. Further research is required to validate the conclusion that a severity score cannot be used as a triage tool.
Asunto(s)
Cuidados Críticos , Triaje/métodos , Adolescente , Adulto , Anciano , Femenino , Capacidad de Camas en Hospitales , Hospitales Comunitarios , Hospitales de Enseñanza , Humanos , Masculino , Persona de Mediana Edad , New Jersey , Índice de Severidad de la EnfermedadAsunto(s)
Ciprofloxacina/efectos adversos , Síndrome de Stevens-Johnson/inducido químicamente , Síndrome de Stevens-Johnson/diagnóstico , Infecciones Estreptocócicas/complicaciones , Tonsilitis/complicaciones , Adulto , Ciprofloxacina/uso terapéutico , Humanos , Masculino , Penicilina G/uso terapéutico , Síndrome de Stevens-Johnson/tratamiento farmacológico , Infecciones Estreptocócicas/tratamiento farmacológico , Infecciones Estreptocócicas/fisiopatología , Streptococcus pyogenes/aislamiento & purificación , Tonsilitis/tratamiento farmacológico , Tonsilitis/microbiologíaRESUMEN
Severity scoring systems are time consuming for physicians and other health professionals. In addition, they are unlikely to be used by resident physicians wishing to have a quantitative measure of a patient's severity. The authors describe a new critical care scoring system.
Asunto(s)
Cuidados Críticos , Índice de Severidad de la Enfermedad , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Femenino , Humanos , Masculino , Persona de Mediana Edad , PronósticoRESUMEN
Due to Operation Desert Storm, St. Francis Medical Center established an inhouse triage system to make bed space rapidly available during out-of-hospital disasters. The authors discuss the use of physician bed monitors and discharge criteria and suggest the importance of hospital readiness.