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BackgroundKounis syndrome corresponds to the occurrence of myocardial injury following an allergic insult. This syndrome is infrequent, and is not well known. In consequence, it is usually misdiagnosed leading to inappropriate treatment. The current literature is limited to case studies and there are no international recommendations concerning this topic.Case presentationWe discussed, through two case reports, the clinical presentation and the management of a 60-year-old North African man and a 45-year-old North African man presenting with chest pain suggesting acute coronary syndrome following anaphylactic reaction. Triggering factors were a drug in the first case and herbal dermal exposure in the second. A clinical examination and electrocardiogram revealed anaphylactic reaction associated with myocardial infarction. Appropriate management of these two life-threatening conditions allowed an improvement in our patients’ condition and their transfer to specialized units.ConclusionsAlthough Kounis syndrome is a rare phenomenon, physicians should be aware of its physiopathological mechanisms in order to treat it appropriately. The difficulty lies in the fact that the treatment of either of the two associated entities may worsen the other injury.Electronic supplementary materialThe online version of this article (doi:10.1186/s13256-017-1310-7) contains supplementary material, which is available to authorized users.

Introduction Prehospital management of traumatic pain is commonly based on morphine while locoregional analgesia techniques, especially the femoral nerve block (FNB), can be safely and efficiently used. Adjuvants uses can reduce local anesthetic doses and decrease their related risk. The aim of the study was to assess the analgesic effect of magnesium sulfate when used as an adjuvant in prehospital FNB. Methods This is a randomized double-blinded trial conducted in a prehospital medical department of an academic hospital. Patients with isolated diaphysial femoral fracture and eligible to participate were randomized into 2 groups. Group C had a FNB with 15 ml of lidocaine with epinephrine (300 mg) and 3 ml of normal saline solution. Group I had a FNB with 15 ml of lidocaine with epinephrine (300 mg) and 3 ml of MgS 15% (450 mg). The FNB was performed according to the WINNIE technique. Primary endpoints were morphine consumption and pain intensity during the first 6 hours. Secondary endpoints were the duration of the sensory block, time to the first analgesic request, and side effects occurrence. Results Twenty-four patients were enrolled in each group. Both groups were comparable according to demographic characteristics, initial pain scores, and vital constants. In group I, morphine requirements were significantly lower (2 ± 2 mg versus 5 ± 3 mg, p < 10−3), analgesic onset was significantly faster, and the average time to the first analgesic request was longer (276 ± 139 min versus 160 ± 79 min, p < 10−3). The average duration of sensory block was longer in group I (226 ± 64 min versus 116 ± 70 min p < 10−3). No side effects were recorded. Conclusion Magnesium sulfate should be considered as an efficient and safe adjuvant to lidocaine in prehospital FNB. This trial is registered with (NCT03597945).