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Emergency rectal infusion

Maxim Ben-Yakov, Amal Mattu, William J Brady, Sarah B Dubbs
Several chemotherapeutic agents are known to be cardiotoxic. One of them, 5-fluorouracil (5-FU), has been associated with coronary ischemia and reversible vasospasm. In this report, we describe a 54-year-old man with rectal cancer who developed chest pain during 5-FU infusion. His initial electrocardiogram (ECG), obtained while he was experiencing chest pain, showed hyperacute T waves in the anterolateral leads. Those waves disappeared along with the chest pain after administration of sublingual nitroglycerine...
July 2017: American Journal of Emergency Medicine
Tae Gwan Oh, Won Chul Cha, Ik Joon Jo, Mun Ju Kang, Dong Woo Lee
OBJECTIVE: We aimed to summarize the therapeutic hypothermia (TH) protocols used in emergency departments (EDs) in Korea and to investigate the differences between level 1 and 2 centers. METHODS: The chief residents from 56 EDs were given a structured survey containing questions on the indications for TH, methods for TH induction, maintaining, and finalizing TH treatments. The participants were divided into 2 groups based on their work place (level 1 vs. level 2 centers)...
December 2015: Clinical and Experimental Emergency Medicine
H Reichmann
Both patients and caregivers but also treating physicians are concerned about complications along with surgical interventions. A major problem is abrupt cessation of anti-Parkinson medication, which leads to manifold disturbances, sometimes even to an akinetic crisis. There are several means to guarantee continuous dopaminergic stimulation even in patients that are not allowed to take medication orally before they undergo surgery. Amongst others rectally applied levodopa, amantadine infusions, and especially the use of a rotigotine patch are good means to overcome oral intake...
July 2016: Fortschritte der Neurologie-Psychiatrie
Amanda M Thompson, Carlos R Franco Palacios, Maria N Henriksen
PURPOSE: The concurrent use of intravenous lipid emulsion (ILE) and high-dose insulin (HDI) for the management and treatment of propranolol toxicity in a pediatric patient is described. SUMMARY: A seven-month-old infant (weight, 6.1 kg) was admitted to a hospital emergency department with lethargy and bradycardia after an unintentional overdose of propranolol suspension, which had been prescribed several days previously for treatment of a scalp hemangioma. Notable physical examination and laboratory findings were as follows: blood pressure, 121/84 mm Hg (normal range, 90 ± 30/60 ± 10 mm Hg); heart rate, 62 beats/min (normal range, 100-150 beats/min); respiratory rate, 24 breaths/min (normal range, 25-35 breaths/min); oxygen saturation, 100% on room air; and rectal temperature, 35...
June 15, 2016: American Journal of Health-system Pharmacy: AJHP
Picklu Chaudhuri, Subhra Mandi, Arindam Mazumdar
AIM: With the increasing rate of cesarean delivery (CD) worldwide, there is a need for a revision of practices to prevent post-partum hemorrhage (PPH) after CD. In search of a safe, cheap and effective alternative to oxytocin for prevention of PPH during the postoperative period of CD, the present study aimed to compare rectally administrated misoprostol with i.v. oxytocin infusion. METHODS: A randomized, placebo-controlled, double-blind prospective trial was undertaken on 192 women who did not have risk factors for PPH and who had an uneventful emergency CD under spinal anesthesia...
September 2014: Journal of Obstetrics and Gynaecology Research
Nicholas S Abend, Tobias Loddenkemper
Status epilepticus (SE) is a medical emergency consisting of persistent or recurring seizures without a return to baseline mental status. SE can be divided into subtypes based on seizure types and underlying etiologies. Management should be implemented rapidly and based on pre-determined care pathways. The aim is to terminate seizures while simultaneously identifying and managing precipitant conditions. Seizure management involves "emergent" treatment with benzodiazepines (lorazepam intravenously, midazolam intramuscularly, or diazepam rectally) followed by "urgent" therapy (phenytoin/fosphenytoin, phenobarbital, levetiracetam or valproate sodium)...
July 2014: Current Treatment Options in Neurology
Roberta Caccaro, Edoardo Savarino, Renata D'Incà, Giacomo Carlo Sturniolo
Pulmonary abnormalities are not frequently encountered in patients with inflammatory bowel diseases. However, lung toxicity can be induced by conventional medications used to maintain remission, and similar evidence is also emerging for biologics. We present the case of a young woman affected by colonic Crohn's disease who was treated with oral mesalamine and became steroid-dependent and refractory to azathioprine and adalimumab. She was referred to our clinic with a severe relapse and was treated with infliximab, an anti-tumor necrosis factor α (TNF-α) antibody, to induce remission...
August 28, 2013: World Journal of Gastroenterology: WJG
C E Boulind, P Ewings, S H Bulley, J M Reid, J T Jenkins, J M Blazeby, N K Francis
BACKGROUND: With the adoption of enhanced recovery and emerging new modalities of analgesia after laparoscopic colorectal resection (LCR), the role of epidural analgesia has been questioned. This pilot trial assessed the feasibility of a randomized controlled trial (RCT) comparing epidural analgesia and use of a local anaesthetic wound infusion catheter (WIC) following LCR. METHODS: Between April 2010 and May 2011, patients undergoing elective LCR in two centres were randomized to analgesia via epidural or WIC...
February 2013: British Journal of Surgery
A D Rollstin, S A Seifert
BACKGROUND: There are few reports of acetaminophen overdose in hypothermic patients and even fewer reports describing profound hypothermia. The kinetics, risk of hepatotoxicity, and the possible dose adjustments to N-acetylcysteine (NAC) therapy are not known in this setting. CASE REPORT: A 37-year-old female was found unconscious outside in December and was brought by ambulance to a tertiary care Emergency Department (ED) following a presumed overdose of acetaminophen and diphenhydramine...
January 2013: Clinical Toxicology
Joshua S Broder, Azita G Hamedani, Shan W Liu, Charles L Emerman
BACKGROUND: Controversy exists regarding the need for contrast agents for emergency abdominal computed tomography (CT). OBJECTIVES: We surveyed United States (US) academic Emergency Departments (EDs) to document national practice. We hypothesized variable contrast use for abdominal/pelvic CT, including variance from the American College of Radiology's (ACR) Appropriateness Criteria(®), an evidence-based guideline. METHODS: A survey was sent to physician leaders of US academic EDs, defined as primary site of an Emergency Medicine residency program...
February 2013: Journal of Emergency Medicine
P Dorado, E López-Torres, E M Peñas-Lledó, J Martínez-Antón, A Llerena
Pharmacogenetic studies have shown that genetic defects in drug-metabolizing enzymes encoded by CYP2C9, CYP2C19 genes and by the transporter ABCB1 gene can influence phenytoin (PTH) plasma levels and toxicity. The patient reported here is a 2-year-old girl with a medical history of cryptogenic (probably symptomatic) epilepsy, who had her first focal seizure with secondary generalization at 13 months of age. She initially received oral valproate treatment and three months later, she was prescribed an oral oxcarbazepine treatment...
August 2013: Pharmacogenomics Journal
Yasuyuki Kobayashi, Takashi Hamano, Yoshifumi Kunii, Masaaki Koide
A 77-year-old man diagnosed with rectal cancer and multiple liver metastases underwent transverse colostomy in June 2008, and subsequently underwent radiotherapy of the whole pelvis; chemotherapy was started with 5-FU+l-LV and then switched to mFOLFOX6+bevacizumab. In February 2009, hepatic arterial infusion chemotherapy was carried out because of the exacerbation of appetite loss with chemotherapy and importance of the control of liver metastases. In March 2009, he had redness and swelling of the site of a port and was admitted to our hospital...
August 2010: Gan to Kagaku Ryoho. Cancer & Chemotherapy
Vincent Tremayne
Emergency pre-hospital treatment of haemorrhage includes immediate fluid replacement therapy to restore circulating blood volume, reverse hypotension to perfuse vital organs and reduce the risk of death (National Institute for Clinical Excellence 2004). In remote or rural settings, however, a lack of sterile fluids, intravenous equipment or the knowledge to use them might make this therapy difficult. This article explains why, in such situations, rectal fluid infusion is an easy and effective solution to fluid replacement...
February 2010: Emergency Nurse: the Journal of the RCN Accident and Emergency Nursing Association
Vincent Tremayne
This article describes the use and effectiveness of proctoclysis (rectal fluid infusion) in providing fluid resuscitation in the absence of intravenous access in rural and remote environments.
September 23, 2009: Nursing Standard
Evan R Berg, Supriya D Mehta, Patricia Mitchell, Jorge Soto, Leslie Oyama, Andrew Ulrich
OBJECTIVES: Studies show equivalent accuracy of abdominal computed tomography (CT) using rectal contrast compared with oral contrast for diagnosing appendicitis. The authors evaluated whether emergency department (ED) length of stay and satisfaction differed by route of contrast administration for abdominal CT. METHODS: This before-and-after intervention evaluated adult patients in an urban academic ED who were undergoing abdominal CT to screen for suspected appendicitis...
October 2006: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
Steven P Hodak, Caroline Huang, Donna Clarke, Kenneth D Burman, Jacqueline Jonklaas, Natasa Janicic-Kharic
BACKGROUND: Management of a hyperthyroid patient unable to take oral or rectal medication is a difficult clinical problem. The need for an alternative parenteral route of antithyroid medication administration in thyrotoxic patients occurs in certain rare cases, such as emergent gastrointestinal surgery, bowel ileus or obstruction, or severe vomiting and diarrhea. We report a simple and successful protocol for the preparation and use of intravenous methimazole (MMI) for treatment of hyperthyroidism in patients intolerant of orally and rectally administered thionamides...
July 2006: Thyroid: Official Journal of the American Thyroid Association
Junzo Shimizu, Motoi Kondo, Seizo Masutani, Mutsumi Fukunaga, Hiroyoshi Takemoto, Takahiro Nakayama, Hiroshi Imamura, Masayuki Tatsuta, Manabu Takamura, Yutaka Inoue, Hiroshi Furukawa, Shouho Hayashi, Masayuki Kitada, Takashi Shimano
A 87-year-old male underwent the extended hepatic left lobectomy and the partial hepatectomy (S7, S8) for liver hepatic metastasis from the rectal cancer in March 2003. The reserver was implanted by the GDA-coil method from the right femoral artery, and WHF was enforced 10 times. Epigastric and back pain appeared from January 2004. The pain became strong gradually. MRI and CT scan were examined after hospitalization. These imaging tests showed the pseudo aneurysm of common hepatic artery. Therefore, an emergency angiography was performed, and pseudo aneurysm of the common hepatic artery was embolized with 36 metallic coils...
October 2005: Gan to Kagaku Ryoho. Cancer & Chemotherapy
Shinji Nakamura, Tomoki Nishmyama, Kazuo Hanaoka
Thyroid storm can develop in patients with longstanding untreated hyperthyroidism. It is more often precipitated by an acute event such as surgery, trauma, or infection. We experienced a case in whom thyroid storm occurred during surgery, while he had no preoperative diagnosis of thyroid disease. A 30-year-old man was scheduled for left tympanoplasty. Anesthesia was induced and maintained with sevoflurane and nitrous oxide in oxygen. Heart rate and rectal temperature went up to 140 beats x min(-1) and 39 degrees C, respectively, in 3 hours during surgery...
April 2005: Masui. the Japanese Journal of Anesthesiology
Toshihiro Nakabayashi, Michiaki Kudo, Toshiaki Hirasawa, Hiroyuki Kuwano
This is a report on a case of arteriovenous malformation of the jejunum, which is a relatively rare occurrence that can be detected by helical computed tomography (helical CT). The patient was a 63-year-old man who was admitted to our hospital because of a tarry stool. He developed hypotension as a result of losing a large amount of bright-red blood through rectal bleeding and was given fluids and blood transfusions. Subsequently, a helical CT scan was performed at 10-mm slice thickness. A small high-density area in the jejunum was identified on the arterial phase, which was scanned 30 sec after an intravenous infusion of 100 mL of iopamidol at a rate 2...
July 2004: Hepato-gastroenterology
Wolfgang Miehsler, Walter Reinisch, Lili Kazemi-Shirazi, Clemens Dejaco, Gottfried Novacek, Peter Ferenci, Friedrich Herbst, Judith Karner, Béla Téleky, Ewald Schober, Harald Vogelsang
BACKGROUND: Infliximab (Remicade), a chimeric monoclonal antibody against tumor necrosis factor alpha (TNF-alpha), has emerged as promising therapeutic option in perianal fistulizing Crohn's disease (CD). However, little knowledge exists about its use for the treatment of internal fistulas in CD. We present our experience with infliximab in this situation. METHODS: Four patients with CD who had internal fistulas (Case 1: entero-enteral and entero-abdominal; Case 2: entero-enteral; Case 3: entero-enteral and parastomal; Case 4: entero-vesical) were treated with 3 infusions of infliximab (5 mg/kg body weight) with intervals of 2 and 4 weeks...
January 2004: Inflammatory Bowel Diseases
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