The time from dose administration to clinical response for naloxone was longer for the IN route, but the overall time from patient contact to response was the same for the IV and IN routes. Given the difficulty and potential hazards in obtaining IV access in many patients with narcotic overdose, IN naloxone appears to be a useful and potentially safer alternative.

No abstract

Generalized edema due to water retention is a very rare complication of insulin therapy. It affects mainly patients with newly diagnosed diabetes or patients with chronic hyperglycemia following initiation of insulin therapy. When it occurs, it is treated effectively with diuretics. This case report describes a female patient, who developed severe insulin edema following initiation of insulin. Diuretics were not given due to severe side effects, thus the natural outcome of insulin edema was observed. Edema was gradually replaced by fat tissue with persistent weight gain. Physicians treating diabetic patients should be aware of "insulin edema" in the differential diagnosis of weight gain in patients treated with insulin.

As part of an emergency medical system protocol, national park service rangers certified at the level of an emergency medical technician-basic (EMT-B) are taught to recognize and treat high-altitude pulmonary edema and high-altitude cerebral edema. In Sequoia and Kings Canyon National Parks, this is done with the assistance of physician on-line medical control as a backup. High-altitude pulmonary edema and high-altitude cerebral edema are both potentially fatal altitude illnesses that can be particularly problematic in the backcountry, where evacuation may be delayed. We report a case of high-altitude pulmonary edema and high-altitude cerebral edema occurring at moderate altitude that was successfully treated by park rangers with the Gamow Bag.