RESUMEN
The case of a 57-year-old male athlete who developed acute hyponatremia during participation in a 100 mile ultra-marathon is discussed. The initial presentation was one of rapid neurological deterioration and transient cardiovascular instability. Current theories on how hyponatremia develops in athletes are discussed. Treatment modalities, such as the use of hypertonic saline and the management of increased intracranial pressure, are addressed. With increasing interest in ultra-endurance events, the incidence of acute hyponatremia may increase. It is important that emergency physicians recognize this phenomenon and be familiar with the principles of acute intervention.
Asunto(s)
Hiponatremia/etiología , Carrera/lesiones , Enfermedad Aguda , Electrólitos/sangre , Servicio de Urgencia en Hospital , Humanos , Hiponatremia/sangre , Hiponatremia/diagnóstico , Hiponatremia/epidemiología , Hiponatremia/terapia , Incidencia , Presión Intracraneal , Masculino , Persona de Mediana Edad , Concentración Osmolar , Reflejo Pupilar , Factores de Riesgo , Solución Salina Hipertónica/uso terapéuticoRESUMEN
The case of a 42-year-old latex-sensitive female who experienced urticaria, pruritus, soft tissue swelling, and significant hypotension during an outpatient barium enema is described. These signs and symptoms of anaphylaxis occurred immediately after enema tip insertion and before infusion of contrast material. The patient responded well to appropriate emergency therapy and her symptoms resolved in a 24-hour period. Subsequent radioallergosorbent test showed an elevated immunoglobulin E (IgE) level to latex, and the skin prick test produced significant induration and erythema in response to latex. This patient experienced an IgE-mediated anaphylactic reaction to the latex enema tip. Emergency physicians need to be aware of the spectrum of latex-induced allergic reactions.
Asunto(s)
Anafilaxia/inducido químicamente , Enema/instrumentación , Inmunoglobulina E/sangre , Goma/efectos adversos , Adulto , Anafilaxia/sangre , Anafilaxia/diagnóstico , Anafilaxia/terapia , Sulfato de Bario , Urgencias Médicas , Femenino , Humanos , Prueba de Radioalergoadsorción , Pruebas CutáneasRESUMEN
Acute encephalitis is an unusual manifestation of cat-scratch disease. The authors present the case of a 27-year-old man who exhibited the acute onset of encephalitis manifested by violent behavior and confusion. The diagnosis of drug abuse was presumed initially, but a careful examination revealed the true cause to be cat-scratch disease. Emergency physicians are frequently faced with the challenging task of evaluating confused and combative patients. This case demonstrates the importance of a complete physical examination and a thorough laboratory evaluation.
Asunto(s)
Agresión , Enfermedad por Rasguño de Gato/diagnóstico , Adulto , Enfermedad por Rasguño de Gato/complicaciones , Confusión , Diagnóstico Diferencial , Encefalitis/diagnóstico , Encefalitis/etiología , Humanos , Masculino , Trastornos Relacionados con Sustancias/diagnósticoRESUMEN
A 59 year old white woman had an out of hospital sudden cardiac arrest. Resuscitation at the scene restored spontaneous pulse, blood pressure and respiration but cardiovascular collapse recurred within 30 minutes of hospital arrival. Medically refractory cardiogenic shock of unclear origin prompted the placement of an intraaortic balloon pump, and hemodynamic stabilization was achieved over several hours. Acute rupture of the chordae tendineae of myxomatous mitral valve was diagnosed as the cause of the cardiac arrest. Mitral valve replacement was performed and the patient made an uneventful recovery. This report describes the first known case of rupture of a myxomatous mitral valve presenting as sudden cardiac death. The differential diagnosis of sudden death in this disorder is reviewed, the role of mechanical circulatory assistance in refractory cardiac arrest is discussed and several interesting hemodynamic aspects of the case are considered.
Asunto(s)
Paro Cardíaco/etiología , Rotura Cardíaca/complicaciones , Válvula Mitral , Femenino , Paro Cardíaco/terapia , Humanos , Contrapulsador Intraaórtico , Persona de Mediana Edad , Prolapso de la Válvula Mitral/complicaciones , ResucitaciónRESUMEN
Two patients presented with signs and symptoms of apparent zomepirac-induced anaphylactic shock. All recovered with appropriated therapy. The theories of the mechanisms by which nonsteroidal anti-inflammatory drugs cause this serious adverse reaction are discussed.
Asunto(s)
Anafilaxia/inducido químicamente , Antiinflamatorios/efectos adversos , Pirroles/efectos adversos , Tolmetina/efectos adversos , Adulto , Femenino , Humanos , Hipotensión/inducido químicamente , Masculino , Persona de Mediana Edad , Tolmetina/análogos & derivadosRESUMEN
This study evaluated the use of radionuclide venography (RNV) as a screening test for patients with signs and symptoms of deep venous thrombosis (DVT). Seventy patients underwent RNV; 27 of the 70 patients also had contrast venography. The incidence of DVT was 19% (13 of 70). RNV had an observed sensitivity of 93% and an observed specificity of 100%. Follow-up at one month revealed no evidence of thromboembolic disease in patients with a negative scan. RNV is an accurate, practical screening test for DVT.