Introduction: Emergency physicians frequently encounter critically ill patients in circulatory shock requiring definitive airway procedures. Performing rapid sequence intubation in these patients without blood pressure correction has lethal complications. Questioning the efficacy and fearing side effects of push-dose pressors (PDP) has created an obstacle for their use in the emergency department (ED) setting. In this case series we describe the efficacy and side effects of PDP use during peri-intubation hypotension in the ED. Case series: We included 11 patients receiving PDPs in this case series. The mean increase in systolic blood pressure was 41.3%, in diastolic blood pressure 44.3%, and in mean arterial pressure 35.1%. No adverse events were documented in this case series. Conclusion: The use of push-dose pressors during peri-intubation hypotension may potentially improve hemodynamic status when used carefully in the ED.

Geroderma osteodysplasticum (GO; MIM 231070) is characterized by a typical progeroid facial appearance, wrinkled, lax skin, joint laxity, skeletal abnormalities with variable degree of osteopenia, frequent fractures, scoliosis, bowed long bones, vertebral collapse, and hyperextensible fingers. The disorder results from mutations in the GORAB - golgin, RAB6 interacting. This gene encodes a member of the golgin family, a group of coiled-coil proteins on golgin. That maps to chromosome 1q24. The encoded protein has a function in the secretory pathway. Was identified by-teIrminal kinase-like protein, and thus it may function in mitosis? Mutations in this gene have been associated with geroderma osteodysplastica. Herein, we describe the clinical presentation of one young male patient from related Saudi parents. mutations, a homozygous Frameshift mutation (c.306dup p.(pro 103 Thrfs*20). Interestingly, phenotypic variability was observed in this patient with GO features that were atypical than the cases reported in the literature. As he looks tall stature where the most of cases reported were short and arachnodactyly of fingers which mimic and other syndromes.

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Acute pyelonephritis is a bacterial infection that causes kidney inflammation. Pyelonephritis is a kidney infection that develops as a result of an ascending urinary tract infection that travels from the bladder to the kidneys. Acute pyelonephritis affects over 250,000 people each year, resulting in more than 100,000 hospitalizations. Infection with Escherichia coli is the most prevalent cause. Fever, vomiting, abdomen or loin discomfort, and fatigue are all symptoms of acute pyelonephritis, however Fever is the most clinically useful symptom. Escherichia coli is the causative agent in more than 80% of instances of acute pyelonephritis. Staphylococcus saprophyticus, and enterococci are among the other etiologic factors. While Infections caused by Klebsiella, Enterobacter, Clostridium, or Candida are more common in diabetic patients. Acute pyelonephritis can be treated as an outpatient or as an inpatient procedure. Outpatient treatment is available for healthy, young, non-pregnant women with uncomplicated pyelonephritis. The choice of first-line oral antibiotics depends on local antibiotic resistance characteristics, although trimethoprim alone or in combination with sulphamethoxazole, cephalexin, or amoxicillin-clavulanic acid. In this article we will be looking the causes and management of acute pyelonephritis.