Hydrogen sulfide is a significant occupational health hazard. Education, personal protective equipment, and early treatment are important in improving outcomes.
The live, attenuated 17D vaccine against yellow fever has been used effectively as a vaccine for more than 50 years. Yellow fever was the third human disease to be controlled by vaccination, after smallpox and rabies.2 Currently, the yellow fever vaccine is manufactured by six World Health Organization-approved institutes worldwide. 2 The yellow fever vaccine is used as a routine immunization for infants in many countries, and a valid certificate of vaccination is required for travelers to enter 127 countries worldwide.
3The I7D vaccine is thought to be a safe, preventative therapy against the development of yellow fever in patients at risk for the disease. However, a very small number of patients can have an atypical response to the vaccine, which, as in our patient, can result in death.
Case ReportA 22-year-old female presented to the Emergency Department with a 4-day history of vomiting and 3 days of diarrhea. She had up to 15 episodes of emesis per day (continued next page)
Key Points• Disseminated yellow fever infection can occur from yellow fever vaccine, though predisposing host factors are not known.• Yellow fever vaccine-associated viscerotropic disease must be considered in any patient with multiorgan system failure occurring several days after receiving the yellow fever vaccine. • Treatment for yellow fever vaccine-associated viscerotropic disease, like treatment for wild-type yellow fever virus infection, is largely supportive at this time.• In areas endemic with yellow fever, the vaccine remains the most effective prevention against the disease.
Anti-arrhythmic drugs (AADs) uniquely affect the various electrolyte channels in the heart and can slow conduction, increase refractoriness, and/or decrease automaticity with the goal of preventing tachyarrhythmias. Due to these properties, these same drugs are by nature pro-arrhythmic. Vaughan-Williams classification Ic AADs belong to a class of medications that inhibit sodium channels, leading to decreased conduction velocity of myocytes and Purkinje fibers as well as to decreased automaticity of pacemaker cells. When present in toxic amounts, this leads to classic changes on the electrocardiogram (ECG) that are harbingers of potentially lethal arrhythmias. Presented is a clinical series of ECGs that occurred in a patient who presented with flecainide toxicity.
Typical atrial flutter is a common atrial tachyarrhythmia. Symptoms are typically related to the rate of ventricular response. Although atrial flutter with 1:1 atrioventricular conduction is rare, it is important to recognize because it may precipitate rapid hemodynamic compromise. The authors present a case of exercise-induced 1:1 atrioventricular conduction in a patient with typical atrial flutter.
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