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https://www.readbyqxmd.com/read/29760857/retrospective-chart-review-of-synthetic-cannabinoid-intoxication-with-toxicologic-analysis
#1
Payal Sud, Miles Gordon, Laura Tortora, Matthew Stripp, Damon Borg, Adam Berman
Introduction: Use of synthetic cannabinoids (SC) has recently emerged as a new drug epidemic. Our emergency departments (EDs) received a surge of SC users presenting with lethargy and bradycardia, contrasting prior reports of SC-induced tachycardia and agitation. Our goal was to describe these novel presentations and characterize the compounds. Methods: We present a case series of patients with SC intoxication who presented to our toxicology service covering two tertiary care EDs between 2/11/2015 and 6/23/2015...
May 2018: Western Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29759261/deriving-a-framework-for-a-systems-approach-to-agitated-patient-care-in-the-emergency-department
#2
Ambrose H Wong, Halley Ruppel, Lauren J Crispino, Alana Rosenberg, Joanne D Iennaco, Federico E Vaca
BACKGROUND: The rising agitated patient population presenting to the emergency department (ED) has caused increasing safety threats for health care workers and patients. Development of evidence-based strategies has been limited by the lack of a structured framework to examine agitated patient care in the ED. In this study, a systems approach from the patient safety literature was used to derive a comprehensive theoretical framework for addressing ED patient agitation. METHODS: A mixed-methods approach was used with ED staff members at an academic site and a community site of a regional health care network...
May 2018: Joint Commission Journal on Quality and Patient Safety
https://www.readbyqxmd.com/read/29745723/management-of-a-complex-patient-intravenous-olanzapine-use
#3
Phey Yee Goh, Beatrice Huang, Nancy Pehlivan
OBJECTIVE: This case report aims to highlight the challenges faced by mental health clinicians in managing complex medical and psychiatric presentation, with a particular interest in intravenous (IV) olanzapine use outside the emergency department (ED) and intensive care unit setting. CONCLUSION: There is no current prescribing guideline regarding the use of IV olanzapine for acute agitation associated with schizophrenia and bipolar disorder. Most of the literature available regarding the use of IV olanzapine has originated from studies performed in the ED setting, with the majority of studies reporting a favourable efficacy and safety profile for IV olanzapine...
May 1, 2018: Australasian Psychiatry: Bulletin of Royal Australian and New Zealand College of Psychiatrists
https://www.readbyqxmd.com/read/29718649/synthetic-drug-intoxication-in-children-recognition-and-management-in-the-emergency-department-digest
#4
Rahul Shah, Carl R Baum, Kathryn H Pade
When children and adolescents present to the emergency department with agitation or mental status changes, intoxication from synthetic drug use should be in the differential diagnosis. Identifying the responsible compound(s) may be difficult, so asking the patient broad questions and utilizing appropriate diagnostic studies, when indicated, will aid in making the diagnosis and help identify more-serious complications. This issue discusses the challenges presented by the changing chemical formulations of synthetic cannabinoids, cathinones, and phenethylamines; outlines common presentations of intoxication from these substances; and summarizes best practices for evaluating and managing patients who present with intoxication after consumption of these synthetic drugs of abuse...
May 1, 2018: Pediatric Emergency Medicine Practice
https://www.readbyqxmd.com/read/29715257/evaluation-of-richmond-agitation-sedation-scale-rass-in-mechanically-ventilated-in-the-emergency-department
#5
Marianne K Pop, Katelyn R Dervay, Mary Dansby, Carolina Jones
The purpose of this study was to assess Richmond Agitation Sedation Scale (RASS) goal implementation in mechanically ventilated patients sedated in the emergency department (ED), compliance with RASS, and goal achievement. This study was a retrospective chart review at a large Level I trauma academic medical center. Patients who were intubated in the ED or en route to the ED between October 1, 2013, and October 1, 2014, were eligible for inclusion if they met the following criteria: aged 18 years or older, 24 hr or more on mechanically ventilated support receiving continuous sedation and/or analgesia during the first 48 hr of admission, and a hospital stay of 6 days or more...
April 2018: Advanced Emergency Nursing Journal
https://www.readbyqxmd.com/read/29698346/a-mixed-presentation-of-serotonin-syndrome-vs-neuroleptic-malignant-syndrome-in-a-12-year-old-boy
#6
Christie Sun, Hannah Sweet, Alicia B Minns, Desiree Shapiro, Willough Jenkins
BACKGROUND: Neuroleptic malignant syndrome (NMS) and serotonin syndrome (SS) are serious medical conditions associated with commonly prescribed psychiatric medications. Although the mechanisms differ, they can be clinically difficult to distinguish. We report a case of a pediatric patient with complicated psychiatric history that developed features of both syndromes in the setting of polypharmacy. CASE: A 12-year-old boy with a history of developmental delay, attention-deficit hyperactivity disorder, and posttraumatic stress disorder presented to the emergency department with behavior changes consisting of delayed reactions, gait instability, drooling, and slowed movements...
April 24, 2018: Pediatric Emergency Care
https://www.readbyqxmd.com/read/29697923/synthetic-drug-intoxication-in-children-recognition-and-management-in-the-emergency-department
#7
Rahul Shah, Carl R Baum
When children and adolescents present to the emergency department with agitation or mental status changes, intoxication from synthetic drug use should be in the differential diagnosis. Identifying the responsible compound(s) may be difficult, so asking the patient broad questions and utilizing appropriate diagnostic studies, when indicated, will aid in making the diagnosis and help identify more-serious complications. This issue discusses the challenges presented by the changing chemical formulations of synthetic cannabinoids, cathinones, and phenethylamines; outlines common presentations of intoxication from these substances; and summarizes best practices for evaluating and managing patients who present with intoxication after consumption of these synthetic drugs of abuse...
May 2018: Pediatric Emergency Medicine Practice
https://www.readbyqxmd.com/read/29679414/rates-and-features-of-methamphetamine-related-presentations-to-emergency-departments-an-integrative-literature-review
#8
REVIEW
Rikki Jones, Cindy Woods, Kim Usher
AIMS AND OBJECTIVES: To review the clinical impact methamphetamine has on emergency departments (ED) by assessing the available research on the rates and features of methamphetamine-related presentations. BACKGROUND: Globally, methamphetamine availability, distribution and use has rapidly increased. As a result, the number of methamphetamine-related presentations to EDs has also increased. In this context, it is timely to review the rate and features of methamphetamine-related presentations to understand the impact of methamphetamine on EDs and facilitate the allocation of services, staff and resources...
April 20, 2018: Journal of Clinical Nursing
https://www.readbyqxmd.com/read/29664808/trends-in-pharmacological-emergency-treatment-of-patients-suffering-from-schizophrenia-over-a-16-year-observation-period
#9
Monika Edlinger, Anna-Sophia Welte, Nursen Yalcin-Siedentopf, Georg Kemmler, Felix Neymeyer, W Wolfgang Fleischhacker, Alex Hofer
Patients suffering from schizophrenia are often treated in locked psychiatric units because of psychomotor agitation, hostility and aggressive behavior, or suicidality. Because of legal conditions, investigations on these acutely ill patients are difficult, and many studies do not represent 'real-life psychiatry'. This retrospective survey was conducted at the Department of Psychiatry, Psychotherapy and Psychosomatics of the Medical University, Innsbruck, Austria. Data were collected from the records of all adult inpatients suffering from a schizophrenia spectrum disorder according to the International Classification of Diseases, 10th ed...
April 16, 2018: International Clinical Psychopharmacology
https://www.readbyqxmd.com/read/29656945/ketamine-versus-ketamine-pluses-atropine-for-pediatric-sedation-a-meta-analysis
#10
REVIEW
Jiaxiao Shi, Ang Li, Zhijian Wei, Yang Liu, Cong Xing, Hongyu Shi, Han Ding, Dayu Pan, Guangzhi Ning, Shiqing Feng
OBJECTIVES: The application of atropine for pediatric sedation in the emergency department remains controversial. Our objective was to perform a comprehensive review of the literature and assess the clinical indexes in groups with and without atropine use. METHODS: PubMed, EMBASE, and the Cochrane Library were searched for randomized and non-randomized studies that compared ketamine and ketamine plus atropine for pediatric sedation. The risk ratio with 95% confidence interval was calculated using either a fixed- or random-effects model according to the value of I2 ...
April 5, 2018: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29651740/the-expanding-role-of-ketamine-in-the-emergency-department
#11
Sophia Sheikh, Phyllis Hendry
Patients frequently come to the emergency department for pain. For decades, ketamine has been used in the emergency department for procedural sedation but is now receiving attention as a potential alternative to opioids because of its unique analgesic effects. Additionally, ketamine's dissociative properties have made it a popular choice for sedating profoundly agitated patients. In this narrative review, these new roles for ketamine in the emergency department are discussed.
April 12, 2018: Drugs
https://www.readbyqxmd.com/read/29623620/economic-evaluation-of-midazolam-droperidol-combination-versus-droperidol-or-olanzapine-for-the-management-of-acute-agitation-in-the-emergency-department-a-within-trial-analysis
#12
Celene Y L Yap, Ya-Seng Arthur Hsueh, Jonathan C Knott, David McD Taylor, Esther W Chan, David C M Kong
BACKGROUND: The combination of midazolam and droperidol has proven superior to droperidol or olanzapine monotherapy in the management of acute agitation in emergency departments (EDs). OBJECTIVE: This is the first economic analysis to evaluate the cost-benefit and cost effectiveness of the midazolam-droperidol combination compared with droperidol or olanzapine for the management of acute agitation in EDs. METHODS: This analysis used data derived from a randomised, controlled, double-blind clinical trial conducted in two metropolitan Australian EDs between October 2014 and August 2015...
July 24, 2017: PharmacoEconomics Open
https://www.readbyqxmd.com/read/29613919/addressing-dual-patient-and-staff-safety-through-a-team-based-standardized-patient-simulation-for-agitation-management-in-the-emergency-department
#13
Ambrose H Wong, Marc A Auerbach, Halley Ruppel, Lauren J Crispino, Alana Rosenberg, Joanne D Iennaco, Federico E Vaca
INTRODUCTION: Emergency departments (EDs) have seen harm rise for both patients and health workers from an increasing rate of agitation events. Team effectiveness during care of this population is particularly challenging because fear of physical harm leads to competing interests. Simulation is frequently employed to improve teamwork in medical resuscitations but has not yet been reported to address team-based behavioral emergency care. As part of a larger investigation of agitated patient care, we designed this secondary study to examine the impact of an interprofessional standardized patient simulation for ED agitation management...
April 3, 2018: Simulation in Healthcare: Journal of the Society for Simulation in Healthcare
https://www.readbyqxmd.com/read/29608114/prolonged-toxicity-from-kambo-cleansing-ritual
#14
Kai Li, Howard Horng, Kara Lynch, Craig G Smollin
CONTEXT: Kambo cleanse is a purification, cleansing ritual traditionally performed by South American shaman to confer luck and health to hunters. CASE DETAILS: We report a patient who presented to the emergency department with prolonged symptoms of vomiting, flushing, facial swelling, altered mental status, and agitation requiring chemical restraints, 22 h after a Kambo cleanse. The patient was found with four small, circular, superficial burns to the ankle at the site where the resin was introduced...
April 2, 2018: Clinical Toxicology
https://www.readbyqxmd.com/read/29576825/comparison-of-sedative-effectiveness-of-thiopental-versus-midazolam-in-reduction-of-shoulder-dislocation
#15
Elnaz Vahidi, Rezvan Hemati, Mehdi Momeni, Amirhossein Jahanshir, Morteza Saeedi
BACKGROUND: Various sedative drugs have been proposed to control anxiety and agitation in shoulder dislocation, but none of them has been diagnosed as the best sedative and relaxant agent. The study aimed to compare the sedative effectiveness of thiopental versus midazolam in reduction of shoulder dislocation. METHODS: A randomized double-blind controlled trail was performed in 80 patients with shoulder dislocation recruited from the emergency department. Ten patients were excluded and 70 patients were enrolled in the study...
2018: World Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29551622/treatment-of-behavior-disturbances-with-ketamine-in-a-patient-diagnosed-with-major-neurocognitive-disorder
#16
Douglas Steenblock
A 77-year-old woman who had been previously diagnosed with a major neurocognitive disorder became highly agitated and aggressive in a long-term care facility. She did not respond to intramuscular (IM) haloperidol plus lorazepam and had to be transported to the local emergency department (ED). In the ambulance, she remained highly agitated and was given 200 mg IM ketamine. Within minutes of receiving this, she de-escalated dramatically with no apparent adverse effects and remained stable for several days. Although ketamine has been used recently in pre-hospital settings and EDs to reduce agitated behavior, there has been little if any investigation of its potential for reducing behavior disturbances in patients who suffer from major neurocognitive disorders...
February 26, 2018: American Journal of Geriatric Psychiatry
https://www.readbyqxmd.com/read/29534916/metoclopramide-induced-pheochromocytoma-crisis
#17
James B Leonard, Kashif M Munir, Hong K Kim
Metoclopramide (MCP) is a commonly used anti-emetic in the emergency department (ED). Its use is generally well tolerated; although infrequent adverse reactions such as extrapyramidal reactions or tardive dyskinesia are reported. However, many ED providers are not familiar with the potentially life-threatening hypertensive emergency that can be precipitated by MCP administration in patients with pheochromocytoma. A previously healthy 36-year-old woman presented to the ED with headache and nausea. She developed acute hypertensive emergency (acute agitation, worsening headache, chest pain and wide complex tachycardia) when her blood pressure (BP) increased to 223/102mmHg (initial BP, 134/86mmHg) after receiving intravenous MCP...
March 5, 2018: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29526946/a-retrospective-study-on-the-epidemiological-and-clinical-features-of-emergency-patients-with-large-or-massive-consumption-of-caffeinated-supplements-or-energy-drinks-in-japan
#18
Yoshito Kamijo, Michiko Takai, Yuji Fujita, Kiyotaka Usui
Objective We conducted a retrospective study on the epidemiological and clinical features of patients with acute caffeine poisoning in Japan. Methods Letters requesting participation were sent to 264 emergency departments of hospitals, and questionnaires were mailed to those that agreed to participate. Patients Participants were patients transported to emergency departments of hospitals between April 2011 and March 2016 after consuming large or massive amounts of caffeinated supplements and/or energy drinks (caffeine dose ≥1...
March 9, 2018: Internal Medicine
https://www.readbyqxmd.com/read/29503826/predictive-factors-of-mortality-in-acute-amphetamine-type-stimulants-poisoning-a-review-of-226-cases
#19
Mitra Rahimi, Somaieh Lookzadeh, Roxana Sadeghi, Kambiz Soltaninejad, Shahin Shadnia, Abdolkarim Pajoumand, Hossein Hassanian-Moghaddam, Nasim Zamani, Masoud Latifi-Pour
Introduction: Amphetamine type stimulants (ATS) such as amphetamine and methamphetamine (MA) are one of the most important causes of poisoning in the world. In this study we aimed to define the predictive factors of mortality in acute ATS poisoning patients. Methods: This is a retrospective cross-sectional study on all cases with acute ATS poisoning who were referred to a referral center for poisoning, Tehran, Iran, from April 2011 to March 2014. Using patients' medical records, demographic data, route of exposure, type and amount of ATS, the cause of poisoning, clinical presentations, and electrocardiogram (ECG) and laboratory findings, as well as patient's outcomes were collected and analyzed regarding the independent predictive factors of mortality...
2018: Emergency (Tehran, Iran)
https://www.readbyqxmd.com/read/29433934/evidence-based-review-of-pharmacotherapy-for-acute-agitation-part-2-safety
#20
Leslie S Zun
BACKGROUND: The management of acute agitation in the emergency department often requires the administration of rapid-acting antipsychotic agents. However, there are few comparative studies and little guidance regarding the risks associated with use of such drugs in the acute setting. OBJECTIVE: This structured evidence-based review compared the safety of antipsychotic pharmacotherapies for acute agitation using data from randomized controlled trials identified by a literature search of the PubMed database...
February 9, 2018: Journal of Emergency Medicine
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