Intravenous adenosine in the treatment of junctional tachycardia.
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Adenosine↗
Biomedical subjects
T J Mader
Publications and source records attributed to T J Mader.
Acute diverticulitis in young adults.
Diverticular disease of the colon is generally considered a disease of older patients, rarely causing symptoms before age 40. Two recent cases of ruptured sigmoid diverticulitis in young female patients presenting to our Emergency Department prompted a review of the literature on this topic. Diverticulitis is more common in patients under 40 than previously suspected. Presented are the two cases and a brief summary of the literature review.
Acute Disease↗
A new clinical scoring system fails to differentiate hemorrhagic from ischemic stroke when used in the acute care setting.
Recently, a new diagnostic scoring system has been proposed to help differentiate intracranial hemorrhage (ICH) from ischemic infarct. The system, derived using data from hospitalized stroke patients, is based on eight variables readily available to all clinicians. A diagnostic score <1.0 is reportedly 100% predictive of ischemic infarct. The clinical scoring system is asserted to be a useful adjunct in the initial evaluation of patients with acute stroke syndrome. The purpose of this study was to prospectively evaluate this clinical scoring system in our emergency department (ED). Sixty-one ED patients with focal neurologic deficit undergoing cranial computed tomography (CT) scan to rule out ICH were entered in the study. Thirteen [21% (95% CI, 12-34%)] were found to have an ICH. Twenty-two [36% (95% CI, 24-49%)] had a diagnostic score < 1.0. The CT scans on 4 of these 22 patients showed ICH. The positive predictive value for ischemic infarct for these 22 patients using the diagnostic scoring system was 82% (95% CI, 60-95%). Our results suggest that this new clinical scoring system is of no value in helping to differentiate ICH from ischemic stroke in the acute care setting.
Adult↗
Survival from profound alcohol-related lactic acidosis.
We present the case of a patient with profound alcohol-related lactic acidosis (lactate = 16.1 mmol/L; pH = 6.67) associated with a multitude of metabolic derangements who made a remarkable recovery following aggressive management. The patient was in extremis upon arrival in the emergency department (ED), and resuscitation was begun immediately. While in the ED, the problem list generated included: acute alcohol intoxication, severe lactic acidosis, dehydration, hypothermia, hypoglycemia, acute renal insufficiency, and hepatic failure. Resuscitation continued in the intensive care unit with remarkable improvement and satisfactory outcome. In this patient, the severe lactic acidosis and associated abnormalities were all attributed to acute and chronic effects of ethanol. A brief summary of the proposed mechanism by which these metabolic derangements developed and an outline of her management follows.
Acidosis, Lactic↗