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https://www.readbyqxmd.com/read/28719481/opioid-prescribing-practices-in-pediatric-acute-care-settings
#1
Michelle DePhillips, Jennifer Watts, Jennifer Lowry, M Denise Dowd
OBJECTIVES: Deaths due to prescription opioid overdoses are at record-high levels. Limiting the amount of opioid prescribed has been suggested as a prevention strategy. The purpose of this study was to describe the opioid prescribing practices in the emergency departments and urgent care sites of a Midwestern tertiary care children's hospital system. METHODS: This retrospective medical record review examined the visits from the 2 pediatric emergency departments and 2 pediatric urgent care sites in the system from June 1, 2012, to May 31, 2013, during which an outpatient opioid prescription was written...
July 17, 2017: Pediatric Emergency Care
https://www.readbyqxmd.com/read/28716517/lethal-suicide-attempt-with-a-mixed-drug-intoxication-of-metoprolol-and-propafenone-a-first-pediatric-case-report
#2
Ivana Kacirova, Milan Grundmann, Martin Kolek, Erika Vyskocilova-Hrudikova, Romana Urinovska, Petr Handlos
INTRODUCTION: The β1 adrenergic receptor blocker metoprolol is often prescribed together with the antiarrhythmic drug propafenone. Both are metabolized by cytochrome P450 2D6 and propafenone is also an inhibitor of this enzyme. We present a pediatric case showing metoprolol and propafenone intoxication in combination. CASE: A 14-year-old girl was admitted to a local emergency department after ingestion of metoprolol (probably 1g) and propafenone (probably 1.5-3g) in a suicide attempt...
June 29, 2017: Forensic Science International
https://www.readbyqxmd.com/read/28705745/massive-diltiazem-and-metoprolol-overdose-rescued-with-extracorporeal-life-support
#3
James A Chenoweth, Daniel K Colby, Mark E Sutter, Joshua B Radke, Jonathan B Ford, J Nilas Young, John R Richards
The management of overdoses of cardioactive medications in the emergency department can be challenging. The reversal of severe toxicity from one or more types of cardioactive medication may fail maximal medical therapies and require extreme invasive measures such as transvenous cardiac pacing and extracorporeal life support. We present a case of massive diltiazem and metoprolol overdose refractory to maximal medical therapy, including intravenous calcium, glucagon, vasopressors, high dose insulin, and lipid emulsion...
July 6, 2017: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28692945/impact-of-new-york-prescription-drug-monitoring-program-i-stop-on-statewide-overdose-morbidity
#4
Richard Brown, Moira R Riley, Lydia Ulrich, Ellen Percy Kraly, Paul Jenkins, Nicole L Krupa, Anne Gadomski
BACKGROUND: Prescription Drug Monitoring programs (PDMPs) are intended to reduce opioid prescribing and aberrant drug-related behavior thereby reducing morbidity and mortality due to prescription opioid overdose. Expansion of the New York (NY) State's PDMP in 2013 included the institution of the I-STOP law that mandated clinicians to consult the statewide PDMP database to review the patient's prescription history prior to prescribing opioids. METHODS: Trends in prescription opioid distribution, prescribing, and prescription opioid and heroin overdose morbidity in NY were analyzed using time series...
June 23, 2017: Drug and Alcohol Dependence
https://www.readbyqxmd.com/read/28692400/developing-syndromic-surveillance-to-monitor-and-respond-to-adverse-health-events-related-to-psychoactive-substance-use-methods-and-applications
#5
Michelle L Nolan, Hillary V Kunins, Ramona Lall, Denise Paone
INTRODUCTION: Recent increases in drug overdose deaths, both in New York City and nationally, highlight the need for timely data on psychoactive drug-related morbidity. We developed drug syndrome definitions for syndromic surveillance to monitor drug-related emergency department (ED) visits in real time. MATERIALS AND METHODS: We used 2012 archived syndromic surveillance data from New York City hospitals to develop definitions for psychoactive drug-related syndromes...
July 2017: Public Health Reports
https://www.readbyqxmd.com/read/28692390/use-of-emergency-department-data-to-monitor-and-respond-to-an-increase-in-opioid-overdoses-in-new-hampshire-2011-2015
#6
Elizabeth R Daly, Kenneth Dufault, David J Swenson, Paul Lakevicius, Erin Metcalf, Benjamin P Chan
OBJECTIVES: Opioid-related overdoses and deaths in New Hampshire have increased substantially in recent years, similar to increases observed across the United States. We queried emergency department (ED) data in New Hampshire to monitor opioid-related ED encounters as part of the public health response to this health problem. METHODS: We obtained data on opioid-related ED encounters for the period January 1, 2011, through December 31, 2015, from New Hampshire's syndromic surveillance ED data system by querying for (1) chief complaint text related to the words "fentanyl," "heroin," "opiate," and "opioid" and (2) opioid-related International Classification of Diseases ( ICD) codes...
July 2017: Public Health Reports
https://www.readbyqxmd.com/read/28681615/self-identification-of-nonpharmaceutical-fentanyl-exposure-following-heroin-overdose
#7
Matthew K Griswold, Peter R Chai, Alex J Krotulski, Melissa Friscia, Brittany Chapman, Edward W Boyer, Barry K Logan, Kavita M Babu
OBJECTIVE: To compare user self-identification of nonpharmaceutical fentanyl exposure with confirmatory urine drug testing in emergency department (ED) patients presenting after heroin overdose. METHODS: This was a cross-sectional study of adult ED patients who presented after a heroin overdose requiring naloxone administration. Participants provided verbal consent after which they were asked a series of questions regarding their knowledge, attitudes and beliefs toward heroin and nonpharmaceutical fentanyl...
July 6, 2017: Clinical Toxicology
https://www.readbyqxmd.com/read/28680515/can-patients-with-non-convulsive-seizure-be-identified-in-the-emergency-department
#8
Gholamreza Sadeghipoor Roodsari, Geetha Chari, Bryan Mera, Shahriar Zehtabchi
BACKGROUND: Non-convulsive seizure (NCS) is an underdiagnosed, potentially treatable emergency with significant mortality and morbidity. The objective of this study is to examine the characteristics of patients with NCS presenting with altered mental status (AMS) and diagnosed with electroencephalography (EEG), to identify the factors that could increase the pre-test probability of NCS. METHODS: Retrospective study using the data collected prospectively. Inclusion criteria: patients older than 13 years with AMS...
2017: World Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28663006/effect-of-an-emergency-department-opioid-prescription-policy-on-prescribing-patterns
#9
Jerel Chacko, Josh Greenstein, Brahim Ardolic, Nicole Berwald
BACKGROUND: Staten Island University Hospital is located in NYC, where the opioid epidemic has resulted in significant mortalities from unintentional overdoses. In 2013 as a response to the rising threat to our community, our Emergency Department (ED) administration adopted a clinical practice policy focused on decreasing the prescription of controlled substances. The effects of this policy on our provider prescription patterns are presented here. METHODS: A retrospective chart review of patients prescribed opioids from the ED before and after policy implementation was performed...
June 15, 2017: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28651196/dancing-to-death-a-case-of-heat-stroke
#10
K Nadesan, Chandra Kumari, Mohd Afiq
Heat stroke is a medical emergency which may lead to mortality unless diagnosed early and treated effectively. Heat stroke may manifest rapidly, hence making it difficult to differentiate it from other clinical causes in a collapsed victim.(1) We are presenting a case report of twelve patients who were admitted to our emergency department from a music festival held on 13-15th of March 2014. They developed complications arising from a combination of severe adverse weather condition, prolonged outdoor physical exertion due to long hours of dancing and drug-use, resulting in heat stroke...
May 4, 2017: Journal of Forensic and Legal Medicine
https://www.readbyqxmd.com/read/28646524/risk-factors-for-severe-respiratory-depression-from-prescription-opioid-overdose
#11
Lindsay M Fox, Robert S Hoffman, David Vlahov, Alex F Manini
BACKGROUND AND AIMS: Prescription opioid overdose is a leading cause of injury-related morbidity and mortality in the US. We aimed to identify characteristics associated with clinical severity in emergency department patients with prescription opioid overdose. DESIGN: This was a secondary data analysis of adult prescription opioid overdoses from a large prospective cohort of acute overdoses. We examined elements of a typical emergency department evaluation using a multivariable model to determine which characteristics were associated with clinical severity, specifically severe respiratory depression (SRD)...
June 23, 2017: Addiction
https://www.readbyqxmd.com/read/28633650/effects-of-tolvaptan-in-patients-with-acute-heart-failure-a-systematic-review-and-meta-analysis
#12
Chunbin Wang, Bo Xiong, Lin Cai
BACKGROUND: Acute heart failure, which requires urgent evaluation and treatment, is a leading cause for admission to the emergency department. The aim of this meta-analysis was to evaluate the effects of tolvaptan on acute heart failure and compare them with the effects of conventional therapy or placebo. METHODS: The electronic databases PubMed, EMBASE, and the Cochrane Controlled Trial registry were searched from their starting dates to October 24, 2016. Two authors independently read the trials and extracted related information from the included studies...
June 20, 2017: BMC Cardiovascular Disorders
https://www.readbyqxmd.com/read/28633003/assessment-of-selected-overdose-poisoning-indicators-in-health-care-administrative-data-in-4-states-2012
#13
Beth Hume, Barbara Gabella, Jeanne Hathaway, Scott Proescholdbell, Cristy Sneddon, Elizabeth Brutsch, Riley Hedin, Christopher J Drucker
OBJECTIVES: In 2012, a consensus document was developed on drug overdose poisoning definitions. We took the opportunity to apply these new definitions to health care administrative data in 4 states. Our objective was to calculate and compare drug (particularly opioid) poisoning rates in these 4 states for 4 selected Injury Surveillance Workgroup 7 (ISW7) drug poisoning indicators, using 2 ISW7 surveillance definitions, Option A and Option B. We also identified factors related to the health care administrative data used by each state that might contribute to poisoning rate variations...
July 2017: Public Health Reports
https://www.readbyqxmd.com/read/28622073/neighborhood-poverty-and-9-1-1-ambulance-contacts
#14
Josh Seim, Joshua English, Karl Sporer
BACKGROUND: Neighborhood poverty is positively associated with frequency of 9-1-1 ambulance utilization, but it is unclear whether this association remains significant when accounting for variations in the severities and types of ambulance contacts. METHODS: We merged EMS ambulance contact records in a single California county (n = 88,027) with data from the American Community Survey at the census tract level (n = 300). Using tract as a proxy for neighborhood and negative binomial regression as an analytical tool, we predicted 16 outcomes: any ambulance contacts, ambulance contacts stratified by three intervention severities, and ambulance contacts varied by 12 primary impression categories...
June 16, 2017: Prehospital Emergency Care
https://www.readbyqxmd.com/read/28586701/the-extent-of-and-factors-associated-with-self-reported-overdose-and-self-reported-receipt-of-naloxone-among-people-who-inject-drugs-pwid-in-england-wales-and-northern-ireland
#15
Charlotte O'Halloran, Katelyn Cullen, Jaquelyn Njoroge, Lucy Jessop, Josie Smith, Vivian Hope, Fortune Ncube
BACKGROUND: Overdose is a major cause of death among PWID, and for opioid overdoses naloxone administration can reduce harm. However, globally there is limited national level data on the extent of non-fatal overdose and naloxone uptake. The first national level data on the extent of self-reported overdose and self-reported receipt of naloxone among UK PWID, providing a baseline to monitor the impact of the recent policy change regarding naloxone availability, is presented. METHODS: Data on self-reported overdose and receipt of naloxone during the preceding year for 2013-2014 from a national survey of PWID was analysed...
June 3, 2017: International Journal on Drug Policy
https://www.readbyqxmd.com/read/28576389/healthcare-utilization-in-adults-with-opioid-dependence-receiving-extended-release-naltrexone-compared-to-treatment-as-usual
#16
William E Soares, Donna Wilson, Niels Rathlev, Joshua D Lee, Michael Gordon, Edward V Nunes, Charles P O'Brien, Peter D Friedmann
BACKGROUND: Opioid use disorders have reached epidemic proportions, with overdose now the leading cause of accidental death in the United States. Extended release naltrexone (XR-NTX) has emerged as a medication treatment that reduces opioid use and craving. However, the effect of XR-NTX therapy on acute healthcare utilization, including emergency department visits and inpatient hospitalizations, remains uncertain. The objective of the current study is to evaluate hospital-based healthcare resource utilization in adults involved in the criminal justice system with a history of opioid use disorder randomized to XR-NTX therapy compared with treatment as usual (TAU) during a 6-month treatment phase and 12months post-treatment follow up...
May 12, 2017: Journal of Substance Abuse Treatment
https://www.readbyqxmd.com/read/28555165/tissue-hypoperfusion-hypercoagulopathy-and-kidney-and-liver-dysfunction-after-ingestion-of-a-naphazoline-containing-antiseptic
#17
Yuko Ono, Nozomi Ono, Kazuaki Shinohara
Naphazoline is a peripheral α2-adrenergic receptor agonist commonly used as a topical decongestant. In Japan, over-the-counter antiseptics often contain naphazoline to effect local hemostasis. We present the first case involving the development of hypercoagulopathy, with kidney and liver dysfunction, following a naphazoline overdose. A 22-year-old Japanese woman with a history of depression ingested 160 mL of a commercially available antiseptic containing 0.1% naphazoline. Three days later, she was brought to the emergency department because of general fatigue, nausea, and vomiting...
2017: Case Reports in Emergency Medicine
https://www.readbyqxmd.com/read/28551041/emergency-departments-increasingly-administering-medications-through-the-nose
#18
REVIEW
Deborah L McBride
Administering medications through the nose as an alternative to intramuscular or intravenous injections is increasingly popular in emergency departments and out-of hospital settings because it is simple, fast, and can be used in situations where obtaining intravenous access is difficult or time intensive. This article examines the literature and indications for the out-of-hospital and emergency department administration of five commonly used intranasal medications: midazolam (used to sedate children and treat seizures), fentanyl (for pain relief), naloxone (for opioid overdoses), ketamine (to induce anesthesia) and dexmedetomidine (to sedate and relieve pain in children)...
May 24, 2017: Journal of Pediatric Nursing
https://www.readbyqxmd.com/read/28541758/suicide-risk-in-young-men-and-women-after-substance-intoxication
#19
Marlene Stenbacka, Mats Samuelsson, Peter Nordström, Jussi Jokinen
This study investigates suicide and overdoses in 1,119 consecutive patients (64% women), 15 to 34 years of age, presenting at the emergency department after self-poisoning from1994 to 2000 and followed regarding death to 2006. Regression and Kaplan-Meier survival analyses were performed for suicide and other causes of death. The patients had about a 60 times higher risk (SMR = 61.95) of death due to suicide and 26 times higher (SMR = 26.47) for all-cause mortality. Men had a nearly 2 times higher risk for suicide than women and half of the suicides occurred during the first 2 years after admission...
May 25, 2017: Archives of Suicide Research: Official Journal of the International Academy for Suicide Research
https://www.readbyqxmd.com/read/28506855/rates-and-risk-factors-for-opioid-dependence-and-overdose-after-urologic-surgery
#20
Arpeet S Shah, Robert H Blackwell, Paul C Kuo, Gopal N Gupta
INTRODUCTION: Effective pain management is a critical component of the perioperative process, with opioids representing a mainstay of therapy. The opioid epidemic is a growing concern in the United States. The goal of this study was to quantify the risk of opioid dependence or overdose (ODO) among patients undergoing urologic surgery and to identify risk factors of ODO. METHODS: A retrospective review of urologic surgery from 2007-2011. Data sources included the Healthcare Cost and Utilization Project Inpatient, Ambulatory Surgery, and Emergency Department datasets...
May 12, 2017: Journal of Urology
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