Among patients with unstable angina or myocardial infarction without ST-segment elevation, prasugrel did not significantly reduce the frequency of the primary end point, as compared with clopidogrel, and similar risks of bleeding were observed. (Funded by Eli Lilly and Daiichi Sankyo; TRILOGY ACS ClinicalTrials.gov number, NCT00699998.).

Chlorine inhalation can result in significant morbidity and mortality. The most common clinical ramification is mucosal irritation. Rarely, depending upon the degree of exposure, patients can develop acute respiratory distress syndrome. Management is usually supportive with an unproven role for inhaled or systemic corticosteroids. A case of a young woman who developed respiratory failure secondary to acute respiratory distress syndrome from accidental exposure to chlorine fumes at a community swimming pool is described. The patient suffered a prolonged hospitalization with the need for mechanical ventilation. Despite limited data to support the decision, the patient was started on treatment with corticosteroids. She recovered completely from her illness and was discharged home without supplemental oxygen. A concise discussion of chlorine inhalation injury and a literature review on the utility of inhaled and/or systemic corticosteroids for this clinical entity is presented.

Calcium channel antagonists (CCAs) are commonly involved in drug overdoses. Standard approaches to the management of CCA overdoses, including fluid resuscitation, gut decontamination, administration of calcium, glucagon, and atropine, as well as supportive care, are often ineffective. We report on two patients who improved after addition of hyperinsulinemia-euglycemia (HIE) therapy. We conclude with a literature review on hyperinsulinemia-euglycemia therapy with an exploration of the physiology behind its potential use.

Elevated cardiac biomarkers in conjunction with electrocardiographic (ECG) changes are valuable in diagnosing acute coronary syndrome (ACS). Elevated troponin I (TnI), while commonly seen in ACS, can also occur in entities such as sepsis and pulmonary thromboembolic disease. Raised TnI levels in patients with sepsis result from various mechanisms, including hypoperfusion or direct extension of infection to cardiac tissue, and can also serve as an important prognostic indicator. Electrocardiographic changes in sepsis are not as well described. Some of the ECG findings associated with septic shock include loss of QRS amplitude, increase in QTc interval, bundle branch blocks, and development of narrowed QRS intervals with deformed, positively deflected J waves (commonly known as Osborn waves). ST-segment elevations in sepsis are rare and have only previously been noted in a handful of case reports involving patients with septic shock. We present a case of a 59-year-old woman with ST-segment elevations and increased levels of cardiac troponin from Escherichia coli septic shock in the setting of normal coronary angiography.

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