Biomedical subjects

E Brazil

Publications and source records attributed to E Brazil.

3 recordsLinked to original sources

PubMed1998

"Not so immediate" hypersensitivity--the danger of biphasic anaphylactic reactions.

OBJECTIVE: To assess how commonly clinically significant biphasic anaphylactic reactions occur after apparently successful treatment of an anaphylactic reaction. Cases were analysed to determine whether there were any markers that would allow early identification of patients who would subsequently develop a biphasic response. METHOD: Retrospective review of case notes of 34 patients admitted for observation after an anaphylactic reaction that had required treatment with adrenaline. RESULTS: Six patients (18%) had biphasic reactions. No clinical features on initial presentation identified those likely to have a biphasic response. These patients however required significantly more adrenaline to ameliorate their initial symptoms (p = 0.03) compared with those having a simple uniphasic reaction. CONCLUSIONS: Biphasic anaphylactic reactions occur frequently. There are no clinical features that allow identification of patients likely to have a biphasic response. These patients require higher doses of adrenaline to control their initial symptoms and this should be considered a marker for patients who may develop a biphasic response. These results confirm that all patients being discharged after treatment for an acute anaphylactic reaction must be made aware of the risk of a second phase response after apparent clinical resolution.

Adolescent↗

PubMed1998

Computed tomography of the head by the accident and emergency department--why 24 hour access is vital.

OBJECTIVE: To examine the use made of 24 hour access to computed tomography from an accident and emergency (A&E) department and to assess whether clear benefits for patients could be identified by having such a service. METHODS: Retrospective review of 176 cases where computed tomography was ordered by A&E staff of a large teaching hospital over a one year period. RESULTS: 53% of scans were done "out of hours"; 97% of scans performed (171/176) were studies of the brain. Three examinations were of the cervical spine and two were of the chest. 54% of head scans (93/171) were performed for either confirmed or suspected trauma with 46% (78/171) done for medical indications. Only 16% (11/71) of patients who had a head scan for acute trauma required transfer to the regional neurosurgical unit after consultation. Computed tomography was 100% sensitive in the diagnosis of sub-arachnoid haemorrhage. In cases where computed tomography was performed for coma of undetermined origin the pathology causing coma was identified on computed tomography in 50% of cases. CONCLUSIONS: Computed tomography facilities allow comprehensive initial evaluation of the head injured patient and minimise hazardous and expensive transfer of these seriously ill patients. Experience shows that it is a vital tool in the initial differential diagnosis of the comatose patient and therefore must be available for use by senior and middle grade A&E staff on a 24 hour basis.

Craniocerebral Trauma↗

PubMed1998

Fatal flecainide intoxication.

Flecainide acetate is a potent class 1C antiarrhythmic agent used mainly for the treatment of supraventricular arrhythmias. Acute overdose of this drug is rare but frequently fatal. The clinical course of a patient that ingested a large quantity of flecainide as a suicide attempt is described and current therapeutic strategies discussed.

Adult↗