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https://www.readbyqxmd.com/read/27917218/can-we-predict-agitation-in-patients-with-suicide-attempts-in-the-emergency-department
#1
Ayhan Akoz, Sultan Tuna Akgol Gur, Elif Oral, Ummu Zeynep Avsar, Mucahit Emet
BACKGROUND: The agitation in patients presenting to the emergency department (ED) after suicide attempts is common and an important problem. OBJECTIVE: To establish whether we can predict agitated patients among suicide attempt patients in ED. METHODS: This is a cross-sectional observational study of adult suicide attempt events in ED. Information was collected prospectively on a specially designed data-collection form. Patients aged 16 years old and above who presented to the ED for care due to suicide attempts were included in the study...
September 2016: African Health Sciences
https://www.readbyqxmd.com/read/27895451/non-cardiogenic-pulmonary-edema-rhabdomyolysis-and-myocardial-injury-following-heroin-inhalation-a-case-report
#2
G Bazoukis, A Spiliopoulou, K Mourouzis, P Grigoropoulou, A Yalouris
BACKGROUND: Heroin use by non-injecting routes of administration (snorting, swallowing, "chasing the dragon") is considered to be safer but is not risk-free for fatal overdose or serious side effects. We report the case of an adolescent who was transferred unconscious to the emergency department after heroin inhalation. Description of the case: A 17-year-old male was transferred to the emergency department unconscious (Glasgow coma scale: 6/15) after heroin inhalation. He was treated with non-rebreather mask and intravenous infusion of naloxone with gradual improvement of consciousness and arterial blood gasses...
January 2016: Hippokratia
https://www.readbyqxmd.com/read/27884585/the-successful-treatment-of-5-fluorouracil-5-fu-overdose-in-a-patient-with-malignancy-and-hiv-aids-with-uridine-triacetate
#3
Cynthia Santos, Brent W Morgan, Robert J Geller
According to the NIH, about 275000 patients receive treatment with 5-Fluorouracil (5-FU) and more than 1300 die from 5-FU toxicity every year from life-threatening myelosuppression, gastrointestinal complications, and neurotoxicity. Immunocompromised persons are at higher risk of developing toxicity. Recently uridine triacetate (Vistagard®) has been approved by the Food and Drug Administration (FDA) as the only specific antidote available for 5-FU poisoning. In a clinical trial (n=135), 96% of patients with 5-FU toxicity recovered after treatment, where as in a historical control group only 10% survived...
November 15, 2016: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/27884575/brugada-pattern-caused-by-a-flecainide-overdose
#4
Elena Tessitore, Majd Ramlawi, Olivier Tobler, Henri Sunthorn
BACKGROUND: Brugada pattern can be found on the electrocardiogram (ECG) of patients with altered mental status, usually with fever or drug intoxication. Diagnosis remains challenging, because the ECG changes are dynamic and variable. In addition, triggers are not always clearly identified. In patients with atrial fibrillation (AF), the use of class IC antidysrhythmic drugs can unmask a Brugada pattern on the ECG, especially if combined with other medications acting on sodium channels...
November 21, 2016: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/27881107/risk-of-repeated-self-harm-and-associated-factors-in-children-adolescents-and-young-adults
#5
Marco Bennardi, Elaine McMahon, Paul Corcoran, Eve Griffin, Ella Arensman
BACKGROUND: Repeated self-harm represents the single strongest risk factor for suicide. To date no study with full national coverage has examined the pattern of hospital repeated presentations due to self-harm among young people. METHODS: Data on consecutive self-harm presentations were obtained from the National Self-Harm Registry Ireland. Socio-demographic and behavioural characteristics of individuals aged 10-29 years who presented with self-harm to emergency departments in Ireland (2007-2014) were analysed...
November 24, 2016: BMC Psychiatry
https://www.readbyqxmd.com/read/27853105/clinical-characteristics-of-patients-who-overdose-on-multiple-psychotropic-drugs-in-tokyo
#6
Satoshi Hori, Kosaku Kinoshita
OBJECTIVE: The purpose of this study was to identify the clinical aspects leading to overdose of multiple psychotropic drugs, in order to determine areas which need attention in the proper treatment of overdose patients. METHODS: Patients who were treated for overdose of psychotropic drugs at our emergency and critical center over two years were targeted. The clinical data was gathered from the medical records and database of all patients, including age, gender, vital signs, and laboratory data, drugs, and medical complications during hospital stay...
2016: Journal of Toxicological Sciences
https://www.readbyqxmd.com/read/27849133/do-heroin-overdose-patients-require-observation-after-receiving-naloxone
#7
Michael W Willman, David B Liss, Evan S Schwarz, Michael E Mullins
CONTEXT: Heroin use in the US has exploded in recent years, and heroin overdoses requiring naloxone are very common. After awakening, some heroin users refuse further treatment or transport to the hospital. These patients may be at risk for recurrent respiratory depression or pulmonary edema. In those transported to the emergency department, the duration of the observation period is controversial. Additionally, non-medical first responders and lay bystanders can administer naloxone for heroin and opioid overdoses...
November 16, 2016: Clinical Toxicology
https://www.readbyqxmd.com/read/27842792/drug-toxicities-of-common-analgesic-medications-in-the-emergency-department
#8
REVIEW
Mateusz Ciejka, Khoa Nguyen, Martin H Bluth, Elizabeth Dubey
About 75% of patients present to the emergency department with a complaint of pain. There are multiple prescribed and over-the-counter medications that are available for the treatment of pain. Acetaminophen, opioids, and aspirin are commonly used agents that are available as single agents or in combination with other medications. However, all of these agents are susceptible to toxic overdose, which requires prompt recognition through clinical and laboratory assessment modalities and initiation of therapy to reduce the risk of morbidity and mortality...
December 2016: Clinics in Laboratory Medicine
https://www.readbyqxmd.com/read/27810724/age-related-differences-in-self-harm-presentations-and-subsequent-management-of-adolescents-and-young-adults-at-the-emergency-department
#9
Emma Diggins, Rachael Kelley, David Cottrell, Allan House, David Owens
BACKGROUND: Characteristics of self-harm differ across ages, but there is little work identifying age-related differences in younger people. Young people entering adolescence face emotionally and developmentally different challenges to those entering adulthood. This study investigates how Emergency Department (ED) presentations and management of self-harm differ through adolescence and early adulthood. METHODS: 3782 consecutive self-harm episodes involving 2559 people aged 12-25 years were identified from an existing database of Leeds ED attendances from 2004 to 2007...
October 21, 2016: Journal of Affective Disorders
https://www.readbyqxmd.com/read/27788602/can-a-serum-acetaminophen-concentration-obtained-less-than-4-hours-post-ingestion-determine-which-patients-do-not-require-treatment-with-acetylcysteine
#10
Mark C Yarema, Jason P Green, Marco L A Sivilotti, David W Johnson, Alberto Nettel-Aguirre, Charlemaigne Victorino, Daniel A Spyker, Barry H Rumack
CONTEXT: The interpretation of acetaminophen concentrations obtained prior to 4 hours after an acute, single overdose remains unclear. Patient care decisions in the Emergency Department could be accelerated if such concentrations could reliably exclude the need for treatment. OBJECTIVE: To determine the agreement between a serum acetaminophen concentration obtained less than 4 hours after an acute ingestion and the subsequent 4 + hour concentration, and the predictive accuracy of early concentrations for identifying patients with potentially toxic exposures...
October 28, 2016: Clinical Toxicology
https://www.readbyqxmd.com/read/27769615/is-a-prehospital-treat-and-release-protocol-for-opioid-overdose-safe
#11
Daniel Kolinsky, Samuel M Keim, Brian G Cohn, Evan S Schwarz, Donald M Yealy
BACKGROUND: The current standards for domestic emergency medical services suggest that all patients suspected of opioid overdose be transported to the emergency department for evaluation and treatment. This includes patients who improve after naloxone administration in the field because of concerns for rebound toxicity. However, various emergency medical services systems release such patients at the scene after a 15- to 20-min observation period as long as they return to their baseline...
October 18, 2016: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/27763703/performance-measures-of-diagnostic-codes-for-detecting-opioid-overdose-in-the-emergency-department
#12
Christopher Rowe, Eric Vittinghoff, Glenn-Milo Santos, Emily Behar, Caitlin Turner, Phillip Coffin
OBJECTIVES: Opioid overdose mortality has tripled in the USA since 2000 and opioids are responsible for more than half of all drug overdose deaths, which reached an all-time high in 2014. Opioid overdoses resulting in death, however, represent only a small fraction of all opioid overdose events and efforts to improve surveillance of this public health problem should include tracking nonfatal overdose events. International Classification of Disease (ICD) diagnosis codes, increasingly used for the surveillance of nonfatal drug overdose events, have not been rigorously assessed for validity in capturing overdose events...
October 20, 2016: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/27756427/why-is-it-so-hard-to-implement-change-a-qualitative-examination-of-barriers-and-facilitators-to-distribution-of-naloxone-for-overdose-prevention-in-a-safety-net-environment
#13
Mari-Lynn Drainoni, Elisa A Koppelman, James A Feldman, Alexander Y Walley, Patricia M Mitchell, Jacqueline Ellison, Edward Bernstein
BACKGROUND: The increase in opioid overdose deaths has become a national public health crisis. Naloxone is an important tool in opioid overdose prevention. Distribution of nasal naloxone has been found to be a feasible, and effective intervention in community settings and may have potential high applicability in the emergency department, which is often the initial point of care for persons at high risk of overdose. One safety net hospital introduced an innovative policy to offer take-home nasal naloxone via a standing order to ensure distribution to patients at risk for overdose...
October 18, 2016: BMC Research Notes
https://www.readbyqxmd.com/read/27753564/a-3-year-comparison-of-overdoses-treated-in-a-military-emergency-department-complications-admission-rates-and-health-care-resources-consumed
#14
Victoria J Ganem, Alejandra G Mora, Nina Nnamani, Vikhyat S Bebarta
BACKGROUND: Drug overdose has become a leading cause of death in the United States and is a growing issue in civilian and military populations. Increasing prescription drug misuse and poisonings translate into greater utilization of medical resources. Our objective was to describe the incidences of overdoses and their associated events and outcomes following emergency department consult. METHODS: We performed a retrospective cohort study on cases evaluated in 2 military hospital emergency departments over 3 years...
October 2016: Military Medicine
https://www.readbyqxmd.com/read/27749809/pharmacist-outpatient-prescription-review-in-the-emergency-department-a-pediatric-tertiary-hospital-experience
#15
Dhara Shah, Shannon Manzi
OBJECTIVES: This study aimed to assess the frequency, type, and potential severity of errors intercepted by pharmacists on review of discharge prescriptions in a pediatric emergency department (ED). METHODS: This was a retrospective, observational study conducted in the ED of a pediatric teaching hospital. A daily report of prescriptions from the previous day was reviewed by a pharmacist for safety and efficacy. If an intervention was deemed necessary, the prescriber was contacted for clarification...
October 4, 2016: Pediatric Emergency Care
https://www.readbyqxmd.com/read/27747721/rhabdomyolysis-in-clozapine-overdose
#16
Frank G A Jansman, Heleen A Crommelin, Freek J A H van Hout, Jan Meulenbelt
CONTEXT: Clozapine is used for decennia for the treatment of schizophrenia. Agranulocytosis, diabetic ketoacidosis, gastrointestinal hypomotility, and myocarditis are well-known adverse effects of clozapine, which are sometimes life threatening. Here we report a case of rhabdomyolysis upon an acute overdose of clozapine. CASE: A male patient, 36 years, with elevated creatinine kinase levels (9899 U/l), developed rhabdomyolysis afterafter admission to the emergency department...
December 2015: Drug Safety—Case Reports
https://www.readbyqxmd.com/read/27745764/factors-associated-with-participation-in-an-emergency-department-based-take-home-naloxone-program-for-at-risk-opioid-users
#17
Andrew Kestler, Jane Buxton, Gray Meckling, Amanda Giesler, Michelle Lee, Kirsten Fuller, Hong Quian, Dalya Marks, Frank Scheuermeyer
STUDY OBJECTIVE: Although the World Health Organization recommends take-home naloxone to address the increasing global burden of opioid-related deaths, few emergency departments (EDs) offer a take-home naloxone program. We seek to determine the take-home naloxone acceptance rate among ED patients at high risk of opioid overdose and to examine factors associated with acceptance. METHODS: At a single urban ED, consecutive eligible patients at risk of opioid overdose were invited to complete a survey about opioid use, overdose experience, and take-home naloxone awareness, and then offered take-home naloxone...
October 10, 2016: Annals of Emergency Medicine
https://www.readbyqxmd.com/read/27745531/epidemiology-of-emergency-department-visits-for-anxiety-in-the-united-states-2009-2011
#18
Tyra Dark, Heather A Flynn, George Rust, Heidi Kinsell, Jeffrey S Harman
OBJECTIVE: The purpose of this study was to describe the epidemiology of anxiety-related emergency department (ED) visits in the United States and assess the care provided during those visits. METHODS: Data from the 2009-2011 National Hospital Ambulatory Medical Care Survey were used to identify all ED visits in which the patient received a primary anxiety diagnosis or declared anxiety as the reason for the visit (N=1,029). Patient characteristics, treatment provided, and dispositions of these nationally representative visits were assessed...
October 17, 2016: Psychiatric Services: a Journal of the American Psychiatric Association
https://www.readbyqxmd.com/read/27727068/accuracy-of-rapid-sequence-intubation-medication-dosing-in-obese-patients-intubated-in-the-ed
#19
Rahul Bhat, Maryann Mazer-Amirshahi, Christie Sun, Janelle Vaughns, Maria Dynin, Eshetu Tefera, Daryn Towle, Munish Goyal
OBJECTIVE: There are limited data regarding appropriateness of sedative and paralytic dosing of obese patients undergoing rapid sequence intubation (RSI) in the emergency department. The goal of this study was to compare rates of appropriate succinylcholine and etomidate doses in obese and nonobese patients. METHODS: Retrospective review using a database of endotracheally intubated patients using RSI in an urban, tertiary care academic emergency department, from November 2009 to June 2011...
September 28, 2016: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/27727036/an-unusual-case-of-alternating-ventricular-morphology-on-the-12-lead-electrocardiogram
#20
Maura Sammon, Alveena Dawood, Scott Beaudoin, Richard A Harrigan
BACKGROUND: One of the principal tasks of an emergency physician is identifying potentially life-threatening conditions in the undifferentiated patient; cardiac dysrhythmia is an example of such a condition. A systematic approach to a patient with atypical dysrhythmia enables proper identification of such-life threatening conditions. CASE REPORT: We describe a 31-year-old man presenting to the emergency department with an undifferentiated dysrhythmia after naloxone reversal of an opiate overdose...
October 7, 2016: Journal of Emergency Medicine
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