Abstract:
STUDY OBJECTIVE:To develop management guidelines for the treatment of anaphylactoid reactions to intravenous N-acetylcysteine (NAC) and to assess the safety of restarting the infusion after a reaction. METHODS:In phased 1, we used a 6-year retrospective case series of hospitalized patients and a review of the literature to develop the management guidelines for anaphylactoid reactions to intravenous NAC. In phase 2, these guidelines were evaluated prospectively in our poison-control center. RESULTS:In phase 1, the charts of 11 patients with anaphylactoid reactions (9 cutaneous and 2 systemic) were reviewed. In most cases, no treatment or treatment with diphenhydramine alone or with salbutamol was sufficient to continue or restart NAC infusion safely. On the basis of our findings in those patients and on published experience, we concluded that anaphylactoid reactions to intravenous NAC are dose-related and the antihistamines are useful in controlling and in preventing recurrence of anaphylactoid symptoms. We developed the following guidelines: flushing requires no treatment, urticaria should be treated with diphenhydramine, and NAC infusion should be continued in both cases. Angioedema and respiratory symptoms each require the administration of diphenhydramine and symptomatic therapy. In these cases, NAC infusion should be stopped but, when necessary, can be started 1 hour after the administration of diphenhydramine in the absence of symptoms. In phase 2, 50 patients (31 cutaneous and 19 systemic reactions) were treated prospectively with the use of these guidelines. Recurrence of symptoms occurred in only one case involving a deviation from the guidelines. The NAC infusion was restarted immediately after the administration of diphenhydramine in a patient who sustained a systemic reaction. CONCLUSION:Non-life-threatening anaphylactoid reactions to intravenous NAC are treated easily and the infusion may be continued or restarted safely after the administration of diphenhydramine.
journal_name
Ann Emerg Medjournal_title
Annals of emergency medicineauthors
Bailey B,McGuigan MAdoi
10.1016/s0196-0644(98)70229-xsubject
Has Abstractpub_date
1998-06-01 00:00:00pages
710-5issue
6eissn
0196-0644issn
1097-6760pii
S0196064498001735journal_volume
31pub_type
杂志文章,评审abstract::First-responding emergency medical technicians (EMTs) trained to defibrillate have been shown to increase survival from prehospital ventricular fibrillation (VF) almost fourfold in Washington's King County. Using Nebraska ambulance rescue run data from 1982 and published information relating ambulance response time to...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/s0196-0644(84)80331-5
更新日期:1984-12-01 00:00:00
abstract::A prospective study was conducted to determine the usefulness of clinical findings and 25-degree pronation and supination radiologic views to diagnose carpal navicular fractures. All patients presenting to the emergency department during a two-year period who fell on their outstretched hand and had pain and/or swellin...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/s0196-0644(05)82039-6
更新日期:1990-03-01 00:00:00
abstract:STUDY OBJECTIVE:Preoxygenation is important to prevent oxygen desaturation during emergency airway management. The purpose of this study is to describe the use of end tidal oxygen (eto2) during rapid sequence intubation in the emergency department. METHODS:This study was carried out in 2 academic centers in Sydney, Au...
journal_title:Annals of emergency medicine
pub_type: 杂志文章,多中心研究
doi:10.1016/j.annemergmed.2019.01.038
更新日期:2019-09-01 00:00:00
abstract::We present the case of a 27-year-old man who sustained a minor head injury and presented with complaints of headache and vomiting. The diagnosis of vertex epidural hematoma is discussed. ...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/s0196-0644(94)70145-8
更新日期:1994-08-01 00:00:00
abstract:STUDY OBJECTIVES:To confirm the ability of the esophageal detector device (EDD) to indicate positioning of endotracheal tubes (ETTs) in patients intubated under emergency conditions and to compare the performance of the EDD with that of end-tidal carbon dioxide (ETCO2). METHODS:This single-subject study comprising a p...
journal_title:Annals of emergency medicine
pub_type: 临床试验,杂志文章
doi:10.1016/s0196-0644(96)70162-2
更新日期:1996-05-01 00:00:00
abstract:STUDY OBJECTIVE:To evaluate the ability of emergency health care providers and patients to demonstrate the proper use of metered-dose inhalers (MDIs). DESIGN:Prospective cross-sectional survey. SETTING:Five Midwestern community teaching hospitals. PARTICIPANTS:One hundred eighty-five health care providers, comprisin...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/s0196-0644(95)70078-1
更新日期:1995-09-01 00:00:00
abstract::A study was undertaken to assess the efficacy and safety of femoral venous catheterization for resuscitation of critically ill patients in the emergency department setting. From May 1982 to April 1983, 100 attempts were made at percutaneous insertion of a large-bore catheter into the femoral veins of patients presenti...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/s0196-0644(84)80471-0
更新日期:1984-04-01 00:00:00
abstract::The case of a patient who developed severe acute respiratory failure during therapy for salicylate intoxication is described. The individual with aspirin overdose is at risk for this complication because of the potential for treatment modalities to cause or worsen lung edema initiated by the effects of salicylates on ...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/s0196-0644(81)80349-6
更新日期:1981-02-01 00:00:00
abstract::Little is known about the efficacy of CPR in the setting of hypothermia-induced cardiac arrest. We measured organ blood flow produced by conventional closed-chest CPR in eight swine following normothermic KCl-induced cardiac arrest and in seven swine surface-cooled until cardiac arrest occurred. Radiomicrospheres were...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/s0196-0644(86)80173-1
更新日期:1986-04-01 00:00:00
abstract::We examined the performance of a hospital-based mobile coronary care unit staffed by emergency physicians, coronary care nurses, and ambulance personnel in a metropolitan setting (Brisbane, Australia). Our unit attended 2,260 calls during 18 months of operation. Standard dispatched ambulances arrived first to 78% of t...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/s0196-0644(89)80462-7
更新日期:1989-09-01 00:00:00
abstract::In 2013 and 2014, more than 700 deaths were attributed to fentanyl and fentanyl analogues in the United States. Of recent concern is the cluster of unintentional fentanyl overdoses because of tablets thought to be "Norco" purchased on the street in Northern California. U-47700 (trans-3,4-dichloro-N-[2-(dimethyl-amino)...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/j.annemergmed.2016.06.014
更新日期:2017-01-01 00:00:00
abstract:STUDY OBJECTIVE:Allergic reactions are common presentations to the emergency department (ED). An unknown proportion of patients will develop biphasic reactions, and patients are often monitored for prolonged periods to manage potential reactions. We seek to determine the incidence of clinically important biphasic react...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/j.annemergmed.2013.10.017
更新日期:2014-06-01 00:00:00
abstract:STUDY OBJECTIVE:We evaluate associations between pairs of discordant cardiac biomarkers (positive MB band of creatine kinase [CKMB] with negative creatine kinase, positive CKMB with negative cardiac troponin, and positive troponin with negative CKMB) and the presence of acute coronary syndromes in emergency department ...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/j.annemergmed.2006.05.016
更新日期:2006-12-01 00:00:00
abstract:STUDY OBJECTIVE:This study investigated the hypothesis that modern computed tomographic (CT) imaging is sufficient to exclude subarachnoid hemorrhage (SAH) in patients with severe headache. METHODS:All 38,730 adult patients who presented to Hermann Hospital in Houston, Texas, during a 16-month period were prospectivel...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:
更新日期:1998-09-01 00:00:00
abstract::Leeches have been used as a medicinal remedy for years untold. Recently, there appears to have been a resurgence in the use of the medicinal leech, Hirudo medicinalis. Presented is the case of a patient who called the emergency department for advice concerning the management of a bleeding leech bite. We discuss briefl...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/s0196-0644(89)80422-6
更新日期:1989-03-01 00:00:00
abstract:STUDY OBJECTIVE:Dabigatran is a reversible direct thrombin inhibitor recently approved for stroke prevention in patients with atrial fibrillation. An increasing number of patients receiving dabigatran present to the emergency department (ED) with bleeding complications. Unlike vitamin K antagonists, there are no accept...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/j.annemergmed.2013.02.008
更新日期:2013-04-01 00:00:00
abstract:STUDY OBJECTIVE:We determine the incidence of serious bacterial infection in infants presenting to the emergency department (ED) with an apparent life-threatening event. METHODS:This was a prospective cohort study of infants younger than 12 months who were treated at an urban children's hospital ED during 1 year and w...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/j.annemergmed.2008.12.037
更新日期:2009-10-01 00:00:00
abstract::Drinking increases motor vehicle crash likelihood starting at blood alcohol levels as low as .02 mmol/L. Clinical experience tells us that drunken drivers "cycle through" the system many times, presenting opportunities for intervention. We describe the drunken driver's risk of occurrence at each juncture in the cycle ...
journal_title:Annals of emergency medicine
pub_type: 杂志文章,评审
doi:10.1016/s0196-0644(95)70148-6
更新日期:1995-08-01 00:00:00
abstract:STUDY OBJECTIVES:To examine trends in legal handgun purchases from federally licensed dealers and specifically to describe recent changes in age and gender of purchaser and caliber of handguns purchased. METHODS:A cohort study was performed of the adult population of Washington state from 1950 through 1992 using a sta...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/s0196-0644(98)70100-3
更新日期:1998-07-01 00:00:00
abstract:STUDY OBJECTIVE:To determine the effect of the institution of out-of-hospital albuterol treatments for acute asthma on out-of-hospital time intervals emergency department (ED) morbidity. DESIGN:Retrospective chart and ambulance run report review. PARTICIPANTS:All patients who presented with a diagnosis of asthma on t...
journal_title:Annals of emergency medicine
pub_type: 临床试验,杂志文章
doi:10.1016/s0196-0644(94)70205-5
更新日期:1994-11-01 00:00:00
abstract::Hyperkalemia is a life-threatening electrolyte disturbance. The clinical presentation is most commonly related to its effects on cardiac conductivity and contractility, although weakness and respiratory compromise may occur. We describe what we believe to be the first reported case of life-threatening hyperkalemia pre...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/s0196-0644(98)70107-6
更新日期:1998-07-01 00:00:00
abstract:STUDY OBJECTIVES:We sought to compare triage designations derived from in-person and telephone interviews and systematically examine the effect of visual cues, vital signs, and complaint-based protocols on the triage process. METHODS:We conducted a 2-phase, prospective, observational study employing a randomized, cros...
journal_title:Annals of emergency medicine
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1016/s0196-0644(98)70063-0
更新日期:1998-12-01 00:00:00
abstract::To evaluate the hypothesis that all victims of severe blunt trauma require a pelvic radiograph, we prospectively studied all such patients admitted to the Southern New Jersey Regional Trauma Center during a seven-month period. All patients were classified as unconscious; impaired; awake, alert, and symptomatic; or ale...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/s0196-0644(88)80244-0
更新日期:1988-05-01 00:00:00
abstract:STUDY OBJECTIVE:We evaluate the sensitivity of Ohio's 2009 emergency medical services (EMS) geriatric trauma triage criteria compared with the previous adult triage criteria in identifying need for trauma center care among older adults. METHODS:We studied a retrospective cohort of injured patients aged 16 years or old...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/j.annemergmed.2014.04.019
更新日期:2015-01-01 00:00:00
abstract:STUDY OBJECTIVES:To develop a practical procedure for producing a nomogram describing the relationship between the osmolality gap and serum ethanol concentrations that is appropriate for the formulas and analytical methodologies in use at any laboratory. DESIGN:Retrospective review of serum sodium, glucose, urea nitro...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/s0196-0644(05)81899-2
更新日期:1992-11-01 00:00:00
abstract:STUDY OBJECTIVE:This study tests the effect of a brief intervention with emergency department (ED) patients to reduce at-risk drinking. METHODS:We enrolled patients aged 18 years or older who screened positive for at-risk drinking in an urban academic ED and used alternative allocation to assign them to control or int...
journal_title:Annals of emergency medicine
pub_type: 杂志文章,随机对照试验
doi:10.1016/j.annemergmed.2004.10.014
更新日期:2005-07-01 00:00:00
abstract::The American Board of Emergency Medicine gathers extensive background information on emergency medicine residents and the programs in which they train. We present the third annual report on the status of US emergency medicine residency programs. [American Board of Emergency Medicine. Report of the Task Force on Reside...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1067/mem.2000.106388
更新日期:2000-05-01 00:00:00
abstract:STUDY OBJECTIVES:The health care needs of the elderly population are significantly different from those of younger patients and require special knowledge and skills on the part of emergency physicians. The purpose of this study was to identify the nature and extent of geriatric training currently provided to emergency ...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/s0196-0644(05)81029-7
更新日期:1992-07-01 00:00:00
abstract::Clinical studies on the use of magnesium in acute myocardial infarction have yielded contradictory results. While the exact reasons for these discrepancies are unclear, it appears that the timing of magnesium administration is crucial to the success or failure of therapy. Although some studies have shown a significant...
journal_title:Annals of emergency medicine
pub_type: 杂志文章,评审
doi:10.1016/s0196-0644(94)70248-9
更新日期:1994-12-01 00:00:00
abstract::When the abdomen is compressed manually in counterpoint to the rhythm of chest compression, in the performance of interposed abdominal compression-CPR, artificial circulation is approximately doubled in animal experiments and in electronic models of the circulatory system. These studies suggest that external manual co...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/s0196-0644(05)80245-8
更新日期:1993-01-01 00:00:00