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"Toxicology" AND "Overdose" AND "Emergency"

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https://www.readbyqxmd.com/read/29992157/metabolic-profiles-of-propofol-and-fospropofol-clinical-and-forensic-interpretative-aspects
#1
REVIEW
Ricardo Jorge Dinis-Oliveira
Propofol is an intravenous short-acting anesthetic widely used to induce and maintain general anesthesia and to provide procedural sedation. The potential for propofol dependency and abuse has been recognized, and several cases of accidental overdose and suicide have emerged, mostly among the health professionals. Different studies have demonstrated an unpredictable interindividual variability of propofol pharmacokinetics and pharmacodynamics with forensic and clinical adverse relevant outcomes (e.g., pronounced respiratory and cardiac depression), namely, due to polymorphisms in the UDP-glucuronosyltransferase and cytochrome P450 isoforms and drugs administered concurrently...
2018: BioMed Research International
https://www.readbyqxmd.com/read/29915095/prospective-countywide-surveillance-and-autopsy-characterization-of-sudden-cardiac-death-post-scd-study
#2
Zian H Tseng, Jeffrey E Olgin, Eric Vittinghoff, Philip C Ursell, Anthony S Kim, Karl Sporer, Clement Yeh, Benjamin Colburn, Nina M Clark, Rana Khan, Amy P Hart, Ellen Moffatt
BACKGROUND: Studies of out-of-hospital cardiac arrest and sudden cardiac death (SCD) use emergency medical services records, death certificates, or definitions that infer cause of death; thus, the true incidence of SCD is unknown. Over 90% of SCDs occur out-of-hospital; nonforensic autopsies are rarely performed, and therefore causes of death are presumed. We conducted a medical examiner-based investigation to determine the precise incidence and autopsy-defined causes of all SCDs in an entire metropolitan area...
June 19, 2018: Circulation
https://www.readbyqxmd.com/read/29902699/abuse-of-fentanyl-an-emerging-problem-to-face
#3
REVIEW
Katarzyna Kuczyńska, Piotr Grzonkowski, Łukasz Kacprzak, Jolanta B Zawilska
Fentanyl is a potent synthetic opioid used as a narcotic analgesic supplement in general and regional anesthesia as well as in management of persistent, severe chronic pain. Alarming epidemiological and forensic medicine reports, accumulated mainly during the last two decades, point to a growing increase in illicit use of fentanyl, mainly in North America and Europe. Toxicological data indicates that fentanyl use is inextricably linked with polydrug use. There are two main sources of fentanyl on the "recreational" drug market...
August 2018: Forensic Science International
https://www.readbyqxmd.com/read/29772071/to-test-or-not-to-test-the-value-of-toxicology-in-a-delayed-overdose-death
#4
Erin E Walsh, Elisa N Shoff, Mary Elizabeth Zaney, George W Hime, Fintan Garavan, Diane M Boland
A case demonstrating the necessity of thorough death investigation processes where toxicology plays an active role is presented. A 33-year-old white man presented to the emergency room in respiratory distress after an overdose episode where he was revived on the scene by fire rescue. His condition continued to deteriorate and he expired 6 days after the initial incident. No admission specimens were available for testing; however, there were specimens drawn 4 and 5 days after the incident. Drug paraphernalia from the scene was obtained by the laboratory through collaboration with local law enforcement...
May 17, 2018: Journal of Forensic Sciences
https://www.readbyqxmd.com/read/29760852/altered-mental-status-current-evidence-based-recommendations-for-prehospital-care
#5
REVIEW
Ashley Sanello, Marianne Gausche-Hill, William Mulkerin, Karl A Sporer, John F Brown, Kristi L Koenig, Eric M Rudnick, Angelo A Salvucci, Gregory H Gilbert
Introduction: In the United States emergency medical services (EMS) protocols vary widely across jurisdictions. We sought to develop evidence-based recommendations for the prehospital evaluation and treatment of a patient with an acute change in mental status and to compare these recommendations against the current protocols used by the 33 EMS agencies in the State of California. Methods: We performed a literature review of the current evidence in the prehospital treatment of a patient with altered mental status (AMS) and augmented this review with guidelines from various national and international societies to create our evidence-based recommendations...
May 2018: Western Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29652682/kratom-an-emerging-drug-of-abuse-a-case-report-of-overdose-and-management-of-withdrawal
#6
Jack Diep, David Tian Chin, Somdatta Gupta, Faraz Syed, Ming Xiong, Jianguo Cheng
Kratom is an herb indigenous to Southeast Asia with psychoactive opioid compounds, often used as a treatment for chronic pain or opiate withdrawal symptoms. It is legally and readily available via Internet sales and has been identified as an emerging drug of abuse in the United States. Kratom use has been associated with psychosis, seizures, and even death. At lower doses, kratom acts as a stimulant, while at higher doses, it produces analgesia and euphoria. Here, we describe the successful management of kratom overdose and withdrawal in a young man with negative toxicology screens...
April 15, 2018: A&A practice
https://www.readbyqxmd.com/read/29385414/newly-emerging-drugs-of-abuse-and-their-detection-methods-an-aclps-critical-review
#7
Li Liu, Sarah E Wheeler, Raman Venkataramanan, Jacqueline A Rymer, Anthony F Pizon, Michael J Lynch, Kenichi Tamama
Objectives: Illicit drug abuse has reached an epidemic level in the United States. Drug overdose has become the leading cause of injury-related deaths since 2008 due to the recent surge of opioid overdose by heroin, controlled prescription drugs, and nonmethadone synthetic opioids. Synthetic designer drugs such as synthetic cathinones ("bath salts") and synthetic cannabinoids ("Spice" and "K2") continue to emerge and attract recreational users. Methods: The emergence of new drugs of abuse poses a steep challenge for clinical toxicology laboratories...
January 29, 2018: American Journal of Clinical Pathology
https://www.readbyqxmd.com/read/29290509/ambient-mass-spectrometry-for-rapid-diagnosis-of-psychoactive-drugs-overdose-in-an-unstable-patient
#8
Chi-Wei Lee, Yu-Ying Chao, Jentaie Shiea, Jheng-Heng Shen, Hei-Hwa Lee, Bai-Hsiun Chen
A 25-year-old man suffered from consciousness change was sent to our emergency department by friends who reported that they were not sure what had happened to him. Physical examination revealed bilateral pupils dilatation, lethargy, slurred speech, and ataxia. Computer-aided tomographic scan of the brain revealed no definite evidence of intracranial lesions. Routine laboratory tests revealed total physiological turmoil. Despite immediate commencement of aggressive treatment, the patient's condition deteriorated long before the traditional drug screen provided an answer for the identities of the multiple drugs overdose...
March 2018: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29183241/alcohol-involvement-in-suicide-and-self-harm
#9
Celine Larkin, Eve Griffin, Paul Corcoran, Carmel McAuliffe, Ivan J Perry, Ella Arensman
BACKGROUND: Alcohol misuse and alcohol consumption are significant risk factors for suicidal behavior. AIMS: This study sought to identify factors associated with alcohol consumption in cases of suicide and nonfatal self-harm presentations. METHOD: Suicide cases in Cork, Ireland, from September 2008 to June 2012 were identified through the Suicide Support and Information System. Emergency department presentations of self-harm in the years 2007-2013 were obtained from the National Self-Harm Registry Ireland...
November 2017: Crisis
https://www.readbyqxmd.com/read/29150198/comparative-effectiveness-of-extended-release-naltrexone-versus-buprenorphine-naloxone-for-opioid-relapse-prevention-x-bot-a-multicentre-open-label-randomised-controlled-trial
#10
RANDOMIZED CONTROLLED TRIAL
Joshua D Lee, Edward V Nunes, Patricia Novo, Ken Bachrach, Genie L Bailey, Snehal Bhatt, Sarah Farkas, Marc Fishman, Phoebe Gauthier, Candace C Hodgkins, Jacquie King, Robert Lindblad, David Liu, Abigail G Matthews, Jeanine May, K Michelle Peavy, Stephen Ross, Dagmar Salazar, Paul Schkolnik, Dikla Shmueli-Blumberg, Don Stablein, Geetha Subramaniam, John Rotrosen
BACKGROUND: Extended-release naltrexone (XR-NTX), an opioid antagonist, and sublingual buprenorphine-naloxone (BUP-NX), a partial opioid agonist, are pharmacologically and conceptually distinct interventions to prevent opioid relapse. We aimed to estimate the difference in opioid relapse-free survival between XR-NTX and BUP-NX. METHODS: We initiated this 24 week, open-label, randomised controlled, comparative effectiveness trial at eight US community-based inpatient services and followed up participants as outpatients...
January 27, 2018: Lancet
https://www.readbyqxmd.com/read/29123931/rapid-ascending-sensorimotor-paralysis-hearing-loss-and-fatal-arrhythmia-in-a-multimorbid-patient-due-to-an-accidental-overdose-of-fluoxetine
#11
Matthew Herrmann, Prissilla Xu, Antonio Liu
Background: Common side effects of selective serotonin reuptake inhibitors (SSRIs) include tachycardia, drowsiness, tremor, nausea, and vomiting. Although SSRIs have less toxic side effects compared to more traditional antidepressants, serious and life threatening cases of SSRI overdose have been reported. We describe a 24-year-old multimorbid female who presented to the emergency department with rapid onset ascending sensorimotor paralysis, complicated by respiratory and cardiac arrest, found to have fatal levels of fluoxetine by toxicological analysis, not taken in a suicidal act...
2017: Case Reports in Neurological Medicine
https://www.readbyqxmd.com/read/29077662/kratom-an-emerging-drug-of-abuse-a-case-report-of-overdose-and-management-of-withdrawal
#12
Jack Diep, David Tian Chin, Somdatta Gupta, Faraz Syed, Ming Xiong, Jianguo Cheng
Kratom is an herb indigenous to Southeast Asia with psychoactive opioid compounds, often used as a treatment for chronic pain or opiate withdrawal symptoms. It is legally and readily available via Internet sales and has been identified as an emerging drug of abuse in the United States. Kratom use has been associated with psychosis, seizures, and even death. At lower doses, kratom acts as a stimulant, while at higher doses, it produces analgesia and euphoria. Here, we describe the successful management of kratom overdose and withdrawal in a young man with negative toxicology screens...
October 26, 2017: A & A Case Reports
https://www.readbyqxmd.com/read/29046744/clinical-and-epidemiological-characteristics-of-patients-with-acute-drug-intoxication-admitted-to-icu
#13
Jose Orsini, Nanda Din, Ershad Elahi, Anthony Gomez, Salil Rajayer, Ryan Malik, Elie Jean
Background : Drug overdose continues to be the most common cause of acute poisoning worldwide. There has been a substantial increase in drug overdose incidence and prevalence over the past decade, probably as a result of the emergence of new synthetic designer drugs. The purpose of this study is to describe the clinical and epidemiological characteristics of patients with acute drug intoxication admitted to the Intensive Care Unit (ICU). Methods : A single center, prospective, observational study was conducted among all adult patients with clinical signs suggestive of acute drug intoxication admitted from the Emergency Department (ED) to ICU during a 6-month period (September to March)...
October 2017: Journal of Community Hospital Internal Medicine Perspectives
https://www.readbyqxmd.com/read/29040568/u-47700-a-not-so-new-opioid
#14
Timothy P Rohrig, Samuel A Miller, Tyson R Baird
U-47700 was developed by the Upjohn Co. in the 1970s as part of their search for a selective μ-opioid agonist with similar potency as morphine. U-47700 has re-emerged recently in the illicit drug market and is easily and cheaply obtained via the internet as well as on the street, many times falsely sold as another drug. Several fatalities from U-47700 have been reported in scientific literature, often in combination with other intoxicants. This case report describes the first death in south-central Kansas resulting solely from U-47700 intoxication: a 26-year-old white male found dead in his bedroom with apparent drug paraphernalia...
January 1, 2018: Journal of Analytical Toxicology
https://www.readbyqxmd.com/read/29016517/pediatric-poisonings-in-a-rural-ugandan-emergency-department
#15
Katherine L Boyle, Usha Periyanayagam, Kavita M Babu, Brian T Rice, Mark Bisanzo
OBJECTIVE: This study aims to describe pediatric poisonings presenting to a rural Ugandan emergency department (ED), identifying demographic factors and causative agents. METHODS: This retrospective study was conducted in the ED of a rural hospital in the Rukungiri District of Uganda. A prospectively collected quality assurance database of ED visits was queried for poisonings in patients under the age of 5 who were admitted to the hospital. Cases were included if the chief complaint or final diagnosis included anything referable to poisoning, ingestion, or intoxication, or if a toxicologic antidote was administered...
October 9, 2017: Pediatric Emergency Care
https://www.readbyqxmd.com/read/28934186/opioid-overdose-outbreak-west-virginia-august-2016
#16
Joel Massey, Michael Kilkenny, Samantha Batdorf, Sarah K Sanders, Debra Ellison, John Halpin, R Matthew Gladden, Danae Bixler, Loretta Haddy, Rahul Gupta
On August 15, 2016, the Mayor's Office of Drug Control Policy in Huntington, West Virginia, notified the Cabell-Huntington Health Department (CHHD) of multiple calls regarding opioid overdose received by the emergency medical system (EMS) during 3 p.m.-8 p.m. that day. A public health investigation and response conducted by the West Virginia Bureau for Public Health (BPH) and CHHD identified 20 opioid overdose cases within a 53-hour period in Cabell County; all cases included emergency department (ED) encounters...
September 22, 2017: MMWR. Morbidity and Mortality Weekly Report
https://www.readbyqxmd.com/read/28859050/overdose-deaths-related-to-fentanyl-and-its-analogs-ohio-january-february-2017
#17
Raminta Daniulaityte, Matthew P Juhascik, Kraig E Strayer, Ioana E Sizemore, Kent E Harshbarger, Heather M Antonides, Robert R Carlson
Ohio is experiencing unprecedented loss of life caused by unintentional drug overdoses (1), with illicitly manufactured fentanyl (IMF) emerging as a significant threat to public health (2,3). IMF is structurally similar to pharmaceutical fentanyl, but is produced in clandestine laboratories and includes fentanyl analogs that display wide variability in potency (2); variations in chemical composition of these drugs make detection more difficult. During 2010-2015, unintentional drug overdose deaths in Ohio increased 98%, from 1,544 to 3,050...
September 1, 2017: MMWR. Morbidity and Mortality Weekly Report
https://www.readbyqxmd.com/read/28800806/toxicologic-emergencies-in-patients-with-mental-illness-when-medications-are-no-longer-your-friends
#18
REVIEW
Spencer Greene, Erin AufderHeide, Lindsay French-Rosas
Patients with psychiatric disorders are at risk for toxicologic emergencies. Psychotropic medications have numerous effects on the neurologic, cardiac, and other organ systems and interact with other medications, potentially leading to further side effects. It is important to become familiar with accepted psychiatric practice guidelines, common toxidromes, medical sequelae associated with prescribed medications, and the specific workup and treatment of overdoses of frequently prescribed psychotropics.
September 2017: Psychiatric Clinics of North America
https://www.readbyqxmd.com/read/28745848/optimizing-survival-outcomes-for-adult-patients-with-nontraumatic-cardiac-arrest-digest
#19
REVIEW
Julianna Jung, Milana Zaurova
Patient survival after cardiac arrest can be improved significantly with prompt and effective resuscitative care. This systematic review analyzes the basic life support factors that improve survival outcome, including chest compression technique and rapid defibrillation of shockable rhythms. For patients who are successfully resuscitated, comprehensive postresuscitation care is essential. Targeted temperature management is recommended for all patients who remain comatose, in addition to careful monitoring of oxygenation, hemodynamics, and cardiac rhythm...
October 22, 2016: Emergency Medicine Practice
https://www.readbyqxmd.com/read/28735777/heroin-and-fentanyl-overdoses-in-kentucky-epidemiology-and-surveillance
#20
Svetla Slavova, Julia F Costich, Terry L Bunn, Huong Luu, Michael Singleton, Sarah L Hargrove, Jeremy S Triplett, Dana Quesinberry, William Ralston, Van Ingram
BACKGROUND: The study aims to describe recent changes in Kentucky's drug overdose trends related to increased heroin and fentanyl involvement, and to discuss future directions for improved drug overdose surveillance. METHODS: The study used multiple data sources (death certificates, postmortem toxicology results, emergency department [ED] records, law enforcement drug submissions, and prescription drug monitoring records) to describe temporal, geographic, and demographic changes in drug overdoses in Kentucky...
August 2017: International Journal on Drug Policy
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