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Emergency, trauma, toxicology

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
Robert G Walker, Lynn J White, Geneva N Whitmore, Alexander Esibov, Michael K Levy, Gregory C Cover, Joel D Edminster, James M Nania
OBJECTIVE: Physiologic alterations during rapid sequence intubation (RSI) have been studied in several emergency airway management settings, but few data exist to describe physiologic alterations during prehospital RSI performed by ground-based paramedics. To address this evidence gap and provide guidance for future quality improvement initiatives in our EMS system, we collected electronic monitoring data to evaluate peri-intubation vital signs changes occurring during prehospital RSI...
May 2018: Prehospital Emergency Care
Paul Calle, Nora Sundahl, Kristof Maudens, Sarah Mr Wille, Diederik Van Sassenbroeck, Koen De Graeve, Stefan Gogaert, Peter De Paepe, Dieter Devriese, Geert Arno, Peter Blanckaert
Introduction Medical problems are frequently encountered during electronic dance music (EDM) events. Problem There are uncertainties about the frequencies and severity of intoxications with different types of recreational drugs: ethanol, "classical" illicit party drugs, and new psychoactive substances (NPS). METHODS: Statistical data on the medical problems encountered during two editions of an indoor electronic dance event with around 30,000 attendants were retrieved from the Belgian Red Cross (Mechelen, Belgium) database...
February 2018: Prehospital and Disaster Medicine
John R Richards, Sheiva Hamidi, Connor D Grant, Colin G Wang, Nabil Tabish, Samuel D Turnipseed, Robert W Derlet
BACKGROUND: Methamphetamine (MAP) users present to the emergency department (ED) for myriad reasons, including trauma, chest pain, and psychosis. The purpose of this study is to determine how their prevalence, demographics, and resource utilization have changed. METHODS: Retrospective review of MAP patients over 3 months in 2016. Demographics, mode of arrival, presenting complaints, disposition, and concomitant cocaine/ethanol use were compared to a 1996 study at the same ED...
2017: Journal of Addiction
Sylvia L Chang, Vaama Patel, John Giltner, Richard Lee, Catherine A Marco
INTRODUCTION: Eye injury is the second most common cause of visual impairment and a leading cause of monocular blindness in the United States. There are approximately 6 million ED visits related to drug use annually, including misuse or abuse of pharmaceuticals and illicit drug use. The purpose of this study was to assess the relationship between ocular trauma and substance abuse among emergency department patients and to assess that relationship with demographic factors, including age and gender...
November 2017: American Journal of Emergency Medicine
M Braun, C J Ploner, T Lindner, M Möckel, W U Schmidt
Coma of unknown origin (CUO) is a frequent unspecific emergency symptom associated with a high mortality. A fast diagnostic work-up is essential given the wide spectrum of underlying diagnoses that are made up of approximately 50% primary central nervous system (CNS) pathologies and approximately 50% extracerebral, almost exclusively internal medical causes. Despite the high mortality associated with this symptom, there are currently no generally accepted management guidelines for adult patients presenting with CUO...
June 2017: Der Nervenarzt
Bethann M Pflugeisen, Mauricio A Escobar, Dustin Haferbecker, Yolanda Duralde, Elizabeth Pohlson
OBJECTIVE: There has been an increasing movement worldwide to create systematic screening and management procedures for atypical injury patterns in children with the hope of better detecting and evaluating nonaccidental trauma (NAT). A legitimate concern for any hospital considering implementation of a systematic evaluation process is the impact on already burdened hospital resources. We hypothesized that implementation of a guideline that uses red flags related to history, physical, or radiologic findings to trigger a standardized NAT evaluation of patients <4 years would not negatively affect resource utilization at our level II pediatric trauma center...
April 2017: Hospital Pediatrics
Uma N Srivatsa, K Swaminathan, K Sithy Athiya Munavarah, Ezra Amsterdam, K Shantaraman
BACKGROUND: Sudden cardiac death (SCD) is a major cause of mortality secondary to coronary artery disease (CAD) in the industrialized societies. Although South Asians have a high prevalence of CAD, the frequency and underlying pathology of SCD among this population are unknown. METHODS: Medical records of consecutive patients presenting with unexplained sudden death (USD) in a tertiary care center were reviewed. Patients with trauma, violent deaths, positive toxicology and non-cardiac pathology were excluded to determine sudden cardiac death (SCD)...
July 2016: Indian Pacing and Electrophysiology Journal
Veysi Eryigit, Ulas Karaaslan, Melih Yuksel, Caner Saglam, Mehmet Can Girgin, Yoldas Demirtas
INTRODUCTION: There are many academic journals in Turkey and the world. Medical journals have a significant place among those publications. The aim of this study is to examine qualitatively and categorize the scientific studies of the two journals in Turkey. It also aims to contribute the related literature in the area. MATERIAL-METHOD: Academic journals of medical emergencies published in Turkey between January 1, 2003 and December 20, 2014 were investigated in detail...
December 2015: Turkish Journal of Emergency Medicine
Lorin R Browne, Manish I Shah, Jonathan R Studnek, Brittany M Farrell, Linda M Mattrisch, Stacy Reynolds, Daniel G Ostermayer, David C Brousseau, E Brooke Lerner
BACKGROUND: Pediatric prehospital research has been limited, but work in this area is starting to increase particularly with the growth of pediatric-specific research endeavors. Given the increased interest in pediatric prehospital research, there is a need to identify specific research priorities that incorporate the perspective of prehospital providers and other emergency medical services (EMS) stakeholders. OBJECTIVES: To develop a list of specific research priorities that is relevant, specific, and important to the practice of pediatric prehospital care...
May 2016: Prehospital Emergency Care
A Bagher, C J Wingren, A Ottosson, L Andersson, S Wangefjord, S Acosta
BACKGROUND: It is rare that epidemiological surveys of patients with major trauma include both those admitted to the emergency department and those sent for medico-legal autopsy. The main aim of the present population-based study of major trauma was to examine the importance of medico-legal autopsy data. METHODS: A new injury severity score (NISS)>15 or lethal outcome was used as criteria for major trauma and to identify patients at the emergency, anaesthesiology and forensic departments and/or being within the jurisdiction of the Malmö police authority and subjected to a medico-legal autopsy between 2011 and 2013...
August 2015: Injury
Bianca Grecu Jacobs, Samuel D Turnipseed, Anna N Nguyen, Edgardo S Salcedo, Daniel K Nishijima
BACKGROUND: Patients often present to the emergency department (ED) as "found down," with limited history to suggest a primary traumatic or medical etiology. OBJECTIVE: The study objective was to describe the characteristics of "found down" adult patients presenting to the ED as trauma, specifically the incidence of acute medical diagnoses and major trauma. METHODS: Using an institutional trauma registry, we reviewed trauma activations with the cause of injury "found down" between January 2008 and December 2012...
December 2015: Journal of Emergency Medicine
J Inkinen, K Kirjasuo, J Gunn, K Kuttila
BACKGROUND: (1) There is lack of epidemiological data on penetrating trauma in European countries. (2) In Finland most acts of violence are performed under the influence of alcohol. The aim of this study was to determine the incidence and types of injury, treatment and survival of patients with penetrating injuries to the thorax and abdomen. METHODS: This study includes two trauma centers with combined catchment area of approximately 720,000 patients. Patients were identified from patient records using ICD-10 codes...
August 2015: European Journal of Trauma and Emergency Surgery: Official Publication of the European Trauma Society
Ali Bagher, Lina Andersson, Carl Johan Wingren, Anders Ottosson, Sakarias Wangefjord, Stefan Acosta
AIMS: We applied the new injury severity scoring system and studied mechanisms of injury and risk factors for mortality, in order to find potential preventive measures, in the present Scandinavian trauma cohort triaged through red trauma alarm according to the Medical Emergency Triage and Treatment System. METHODS: Individuals were identified in hospital and forensic records. New injury severity scoring system >15 was defined as major trauma. Inter-rater reliability of new injury severity scoring system was expressed as intra-class correlation coefficient with 95% confidence intervals...
July 2015: Scandinavian Journal of Public Health
Norman G Nicolson, Patrick M Lank, Marie L Crandall
BACKGROUND: Recent guidelines recommend universal substance abuse screening for all trauma patients aged 12 years and older because brief interventions can help prevent future trauma. However, little is known about actual rates of screening in this setting. METHODS: The Illinois State Trauma Registry was queried for severely injured patients from 1999 to 2009. Multivariate logistic regression was used to characterize, according to demographic and physiologic parameters, which patients were screened with blood alcohol and urine toxicology and which screened positive...
October 2014: American Journal of Surgery
J A Chenoweth, R R Gerona, J B Ford, M E Sutter, J S Rose, T E Albertson, S O Clarke, K P Owen
INTRODUCTION: Over the past decade, there has been a sharp increase in the number of newly identified synthetic drugs. These new drugs are often derivatives of previously abused substances but have unpredictable toxicity. One of these drugs is gacyclidine, a derivative of phencyclidine (PCP). Gacyclidine has been studied as a neuroprotective agent in trauma and as a therapy of soman toxicity. There are no previous reports of its use as a drug of abuse. CASE REPORTS: During a two-month period in the summer of 2013, a series of patients with severe agitation and end-organ injury were identified in an urban academic Emergency Department (ED)...
March 2015: Journal of Medical Toxicology: Official Journal of the American College of Medical Toxicology
Marcus Oldenburg, Jan Rieger, Christoph Sevenich, Volker Harth
BACKGROUND: On merchant ships, the medical treatment including emergency interventions on the high seas are carried out by nautical officers who have to pass a forty hours medical refresher course every five years in order to meet international requirements. This study aims to show the most frequent kinds of medical emergencies on the high seas and to assess the seafarers' knowledge about their treatment. METHODS: 465 nautical officers who participated in the medical refresher course at the Institute for Occupational and Maritime Medicine in Hamburg, within the period from 2006 to 2013, were interviewed about their experience of serious diseases and accidents on board, which had led to an emergency port call, a course deviation or an evacuation...
2014: Journal of Occupational Medicine and Toxicology
F A Elrouby
Forensic Medicine is fast growing and important branch of medicine. Some subdivisions of this subject like Thanatology, Toxicology are taking their shape separately. Forensic Ophthalmology is one of the newly emerging dimensions of the subject.

A forensic pathologist can gather a lot of medico-legal information by examining the eye both in antemortem and postmortem cases.
Various characteristics of the eye have also been thought to be useful in determination of PMI (postmortem interval). Specifically, authors have proposed measurement of vitreous humor analyses and intraocular pressure studies as a useful tool for this purpose...
October 2013: Journal of Forensic Odonto-stomatology
Gerard O'Connor, Tara McGinty, Sarah Jane Yeung, Daire O'Shea, Alan Macken, Eamon Brazil, Patrick Mallon
BACKGROUND: The affliction of injecting drug use (IDU) has resulted in the emergence of a subgroup of people with a unique set of medical issues. We aimed to describe the emergency department (ED) presentations of IDUs. METHODS: In a prospective observational study over a 3-month period, we identified characteristics of patients with a history of active IDU presenting to the ED. RESULTS: From 1 January 2010 to 31 March 2010, 146 patients with a history of IDU were identified...
August 2014: Emergency Medicine Journal: EMJ
Hyung Jun Moon, Jung Won Lee
Acute Endosulfan poisoning is associated with a high mortality rate in humans, and can exceed 30% [Moon JM, Chun BJ. Acute endosulfan poisoning: a retrospective study. Hum Exp Toxicol 2009;28:309-16]. Prophylactic anticonvulsant therapy for symptomatic patients and aggressive treatment for seizures may limit morbidity, but, no effective antidote is available [Moses V, Peter JV. Acute intentional toxicity: endosulfan and other organochlorines. Clin Toxicol (Phila) 2010;48:539-44]. However, endosulfan poisoning is often completely reversible with the appropriate management [Karatas AD, Aygun D, Baydin A...
May 2013: American Journal of Emergency Medicine
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