1/21. ehrlichiosis with severe pulmonary manifestations despite early treatment.It is generally thought that if patients with ehrlichiosis are treated promptly, life-threatening illness can be avoided. We report a patient who sought medical attention 1 day after the onset of symptoms, was immediately given doxycycline, and still had serious illness with generalized edema, pulmonary infiltrates, acute respiratory distress syndrome, and noncardiogenic pulmonary edema, while receiving replacement intravenous fluids. This case alerts physicians to the serious end of the disease spectrum that can occur even though patients are given prompt, appropriate drug treatment at the onset of illness. Further studies are needed to clearly define the mechanisms involved in pulmonary complications and generalized edema, including noncardiogenic pulmonary edema, in patients with ehrlichiosis.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/21. Drug-induced lung disease.Since there are no diagnostic studies to confirm the presence of a drug-induced lung reaction the physician will make a correct diagnosis only if he is aware of the drugs which have been identified to cause pulmonary reactions and their specific manifestations. Failure to recognize a drug-induced lung disease can lead to significant morbidity and in some cases mortality. The major drug-induced lung diseases are reviewed, the drugs being presented in the context of their clinical use and the reactions on the basis of common pathogenetic mechanisms.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/21. Neurogenic pulmonary oedema after generalized epileptic seizure.The diagnosis 'tonic clonic seizure' is frequently established by emergency physicians on scene. In patients with epilepsy mortality due to accidents, asphyxia, cardiac arrhythmias or postictal neurogenic pulmonary oedema (NPO) is twice as high as in the general population. We report a case of acute pulmonary oedema after a tonic clonic seizure. Following this event, the patient developed respiratory insufficiency and evidence of pulmonary oedema not associated with the classic aetiologies of congestive heart failure, aspiration or toxic exposure. The patient survived the incident after aggressive prehospital treatment, long-term intensive care and subsequent rehabilitation. A systematic case analysis and an introduction to the pathophysiology of NPO are presented. We recommend a positive approach to the management of NPO consisting primarily of interventions to stabilize vital functions, decrease intracranial pressure and normalize vegetative dysregulation. Emergency physicians need to consider the possibility of NPO in all cases of pulmonary oedema of unknown origin.- - - - - - - - - - ranking = 2keywords = physician (Clic here for more details about this article) |
4/21. Breath-holding-like spells in an infant: an unusual presentation of lingual thyroglossal duct cyst.The authors report the case of an infant with a lingual thyroglossal duct cyst who presented with breath-holding-like spells, which actually represented life-threatening ball-valve obstruction of the larynx, leading to hypoxemia and transient cerebral dysfunction. When evaluating apparent breath-holding spells in young infants, physicians should include dynamic, episodic upper airway obstruction in the differential diagnosis.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
5/21. Paroxysmal hypertension, pheochromocytoma, and pregnancy.BACKGROUND: hypertension is the most common medical complication of pregnancy. pheochromocytoma in pregnancy is rare, and if unrecognized, can cause serious perinatal morbidity and mortality. methods: A patient with severe hypertension, postpartum pulmonary edema, and a recognized pheochromocytoma is described. RESULTS: Abdominal palpation after vaginal childbirth reproduced the diagnostic triad of hypertension, headaches, and palpitations. magnetic resonance imaging established the correct diagnosis before biochemical confirmation of excess catecholamine production. The patient responded to alpha-adrenergic receptor blockade with control of her severe hypertension and clearing of pulmonary edema. The best time to diagnose a pheochromocytoma is before delivery because vaginal childbirth stimulates the release of lethal amounts of catecholamines. CONCLUSIONS: The physician who delivers babies must distinguish between labile hypertension and paroxysmal hypertension. Most experts believe that a spontaneous vaginal delivery is contraindicated when the patient has a pheochromocytoma. Postpartum pulmonary edema associated with a pheochromocytoma is unusual. The profound pressor response elicited by palpation of the postpartum abdomen, the failure of medications usually effective in the treatment of a hypertensive crisis, and the use of magnetic resonance imaging to confirm a functioning adrenal adenoma are the features unique to this case.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
6/21. Transient cardiac dysfunction and pulmonary edema in exertional heat stroke.Exertional heat stroke is a medical emergency that uncommonly results in severe cardiac dysfunction. The military physician diagnosed a 19-year-old military recruit from an elite unit to have exertional heat stroke. Immediate treatment in the field with rapid ice water cooling and vigorous fluid administration resulted in pulmonary edema. Transthoracic echocardiography on admission to the emergency department revealed moderate reduction in left and right ventricular function. After treatment, within a few days, rapid myocardial recovery was noted and persisted after 6 months of follow-up. Possible mechanisms of cardiac dysfunction in exertional heat stroke and treatment strategies are discussed. It is suggested that intravenous fluid administration to patients with suspected exertional heat stroke should preferably be done with appropriate hemodynamic monitoring and after cardiac dysfunction has been ruled out.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
7/21. hydrochlorothiazide-induced pulmonary edema: a case report and literature review.A 67-year-old man developed non-cardiogenic pulmonary edema after taking a hydrochlorothiazide (HCTZ) tablet. The symptoms remitted following supportive treatment but recurred after rechallenge. Immunologic studies showed increased immunoglobulin e, negative lymphocyte transformation test when exposed to HCTZ, normal blood lymphocyte subpopulations and complement levels, and negative antinuclear antibodies. We reviewed 22 previous reported cases and emphasized that physicians should be aware of this rare but life-threatening reaction.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
8/21. pulmonary edema following closed-circuit oxygen diving and strenuous swimming.Acute pulmonary edema may be induced by diving and strenuous swimming. We report the case of a diver using closed-circuit, scuba equipment who developed acute dyspnea, hemoptysis, and hypoxemia following a dive in 18 degreesC (64.4 degrees F) water and physical exertion during the swim back to shore. With the growing popularity of recreational scuba diving, emergency physicians are liable to be faced with increasing numbers of diving-related medical problems. diving-induced pulmonary edema should be included in the differential diagnosis of acute hypoxemia, sometimes accompanied by acid-base abnormalities, when this is seen in a diver.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
9/21. Use of the Gamow Bag by EMT-basic park rangers for treatment of high-altitude pulmonary edema and high-altitude cerebral edema.As part of an emergency medical system protocol, national park service rangers certified at the level of an emergency medical technician-basic (EMT-B) are taught to recognize and treat high-altitude pulmonary edema and high-altitude cerebral edema. In sequoia and Kings Canyon National Parks, this is done with the assistance of physician on-line medical control as a backup. High-altitude pulmonary edema and high-altitude cerebral edema are both potentially fatal altitude illnesses that can be particularly problematic in the backcountry, where evacuation may be delayed. We report a case of high-altitude pulmonary edema and high-altitude cerebral edema occurring at moderate altitude that was successfully treated by park rangers with the Gamow Bag.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
10/21. Profiles in patient safety: misplaced femoral line guidewire and multiple failures to detect the foreign body on chest radiography.This article uses a case report and discussion to demonstrate the concept of active and latent failures, and the "systems approach" to the reduction of adverse events in medicine. The case involves an inadvertently misplaced and retained guidewire during femoral vein catheterization using the Seldinger technique, and the subsequent failure to identify the guidewire in the chest despite several chest radiographs and a computed tomography (CT) scan read by radiologists, emergency physicians, and intensivists. This event reveals active failures in the performance of the Seldinger technique, latent failures in the design of the catheter kit, and problems with the current system of interpretation of radiographs. The authors conclude that the design of the catheter kit and the Seldinger technique should be critically examined from a human factors standpoint and that radiographic interpretation is still heavily subject to human error.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
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