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General practitioner assigned in emergency room must have ability to do electrical cardioversion either in emergency, urgent or elective setting. Analgetic sedation is mandatory to avoid severe pain during electrical cardioversion. Limited number of anesthesiologist and emergency setting that need prompt electrical cardioversion warrant of selecting and using of analgetic sedation agents by doctor in emergency room. Characteristics of those agents must have strong analgesic effect and rapid onset and offset, minimize pain and anxiety and maximize amnesia with minimal adverse effect. This paper reviews some randomized control trial of those agents.

Management of STEMI patients consist of initial recognition and diagnosis, early routine medication, and reperfusion therapy. Primary PCI has been set as default strategy for STEMI reperfusion in PCI-capable hospital. Unfortunately, only few STEMI patients can undergo primary PCI as reperfusion therapy, because the number of hospital with invasive capability is still low in many countries, including Indonesia. Because time is critical in reperfusion therapy, the emergency physicians in non-PCI capable hospital have to decide to hold or refer STEMI patients to a hospital with invasive capability. The reperfusion therapy options for STEMI patient presentingto a non-PCI capable hospital are fibrinolytic therapy, or refer to PCI-capable hospital, or both (pharmacoinvasive strategy). This review tried to summarize the evidences as a consideration in choosing the best reperfusion strategy for STEMI patients presenting to non-PCI capable hospital.

Objective: Unusual clinical course Background: Chemotherapy based on 5-fluorouracil (5-FU) is a well-established treatment for solid cancers, including metastatic or advanced colon cancer. Despite its efficacy, 5-FU can cause rare but serious adverse events such as acute neurotoxicity, which presents as symptoms similar to stroke. Case Report: We report the case of a patient who was diagnosed with stage IV colorectal cancer and who underwent chemotherapy with a high dose of 5-FU as part of the FOLFIRI (Folinic Acid, Fluorouracil, Irinotecan) treatment plan. During the seventh, eighth, and ninth cycles of chemotherapy, the patient suffered from severe encephalopathy, and the cause of this condition was determined to the 46-hour continuous intravenous infusion of 5-FU, which was part of the FOLFIRI regimen. Conclusions: 5-FU-induced hyperammonemic encephalopathy is a rare but serious adverse event that requires immediate recognition and treatment. The first step in managing this condition is to halt the 5-FU infusion and provide the patient with high volumes of fluid. Although most cases of 5-FU-induced encephalopathy resolve spontaneously, recurrence is possible if the drug is re-administered to the same patient. Therefore, it is crucial for healthcare providers to closely monitor patients receiving 5-FU chemotherapy and be aware of the signs and symptoms of hyperammonemic encephalopathy. Early intervention can prevent further complications and ensure the best possible outcome for the patient. It is important to note that while 5-FU-induced hyperammonemic encephalopathy is rare, it highlights the importance of closely monitoring patients receiving chemotherapy to identify and treat adverse events promptly. This can help improve patient outcomes and prevent serious long-term complications. [ABSTRACT FROM AUTHOR]