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Nonanesthetic Effects of Ketamine: A Review Article

Ketamine is considered a dissociative anesthetic medication, and it is commonly administered by a parenteral route. It works mainly by blocking the N-methyl-D-aspartate receptor. It inhibits the voltage-gated Na and K channels and serotonin and dopamine reuptake; also, it affects specific receptors, such as α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid, kainate, and aminobutyric acid A receptors. Ketamine appears to […]

A rattlesnake bite wound hours after the incident. There is swelling of the digit and palm with hemorrhagic bullous formation circumferentially around the finger. Erythema is present in the affected digit. The patient reported pain. Presentations like this may lead to unnecessary use of antibiotics. In this case, no antibiotics were administered and no infection developed.

Prophylactic Antibiotics Are Not Needed Following Rattlesnake Bites (video)

Antibiotics are sometimes administered to victims of rattlesnake bites in the hope of preventing infections. Experts in the field recommend that prophylactic antibiotics not be used because secondary infections are rare. Current recommendations are based on a small number of studies conducted in the United States. We decided to reexamine the issue by taking advantage […]


Acute Epigastric Pain as the Cause of Urgent Gastrectomy in a Healthy Patient

A 63-year-old man with no surgical history, taking no medication,was referred to the emergency department for epigastric pain and nausea that had started afew hours earlier. A sore throat had begun 24hours previously. Physical examination revealed normal temperature, hemodynamic stability, a distended abdomen with abdominal guarding that was very painful on palpation, and no mass […]

(A) Ultrasonography demonstrated a linear hypoechoic structure (arrows) in an area of tissue breakdown in the left lobe of the liver. (B) Magnetic resonance imaging (MRI) showed a hypointense, coiled structure (arrows) in an abscess in the liver's left lobe. (C) MRI disclosed a linear hypointense structure—a worm, which is denoted by the arrow—in the abscess in the liver parenchyma. (D) MRI with contrast identified the liver abscess (asterisk) and the nonenhancing, hypointense worm (arrow).

A Worm Hole: Liver Abscess in Ascariasis

A patient with an infection that is often asymptomatic developed an uncommon complication. The 60-year-old woman presented with fever and pain in the epigastrium and right hypochondrium, symptoms that had existed for the previous 5 days. On touch, she was clearly febrile. Her temperature was 38.6°C (101.5°F). Her blood pressure and pulse rate were within […]

close up of gloved hands filling a syringe

Emerging Trends in Pain Medication Management: Back to the Future: A Focus on Ketamine

  Providers face many challenges when faced with pain management. Pain is complex, difficult to understand and diagnose, and especially enigmatic to manage. The discovery of nonopioid agents for pain management has become particularly important considering the ongoing opioid epidemic. This review is focused on revisiting ketamine, an agent that has historically been used for […]

Contrast-enhanced computed tomography of the abdomen in coronal view showing peripancreatic inflammatory changes consistent with acute pancreatitis.

Hypertriglyceridemia-Induced Acute Pancreatitis with Normal Pancreatic Enzymes

To the Editor: The diagnosis of acute pancreatitis requires 2 of the following 3 features: 1) abdominal pain consistent with acute pancreatitis; 2) serum lipase activity (or amylase activity) at least 3 times greater than the upper limit of normal; and 3) characteristic imaging findings of acute pancreatitis.1 Although normal serum amylase levels have been reported […]

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