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https://www.readbyqxmd.com/read/28306366/serum-osmolal-gap-in-clinical-practice-usefulness-and-limitations
#1
George Liamis, Theodosios D Filippatos, Angelos Liontos, Moses S Elisaf
BACKGROUND: Although serum osmolal gap can be a useful diagnostic tool, clinicians are not familiar with its use in clinical practice. OBJECTIVES: The review presents in a series of questions-answers and under a clinical point of view the current data regarding the use of osmolal gap. DISCUSSION: The definition and the best formula used for the calculation of osmolal gap, the main causes of increased osmolal gap with or without increased anion gap metabolic acidosis, as well as the role of concurrent lactic acidosis or ketoacidosis are presented under a clinical point of view...
March 23, 2017: Postgraduate Medicine
https://www.readbyqxmd.com/read/28292506/the-development-and-feasibility-of-a-pharmacy-delivered-opioid-intervention-in-the-emergency-department
#2
Erin L Winstanley, Rebecca Mashni, Sydney Schnee, Nate Miller, Susan M Mashni
OBJECTIVES: To develop a brief intervention and to assess the feasibility of pharmacy-delivered education on opioid safety and overdose prevention in the emergency department. METHODS: A convenience sample of patients (n = 102) approached between May and June 2016 at a single community-based suburban emergency department located in the Midwest. RESULTS: The intervention included scripted counseling to be delivered in person and 2 educational brochures...
March 2017: Journal of the American Pharmacists Association: JAPhA
https://www.readbyqxmd.com/read/28264750/bilateral-nail-gun-traumatic-brain-injury-presents-as-intentional-overdose-a-case-report
#3
Judith Alain, Pascal Lavergne, Maude St-Onge, Myreille D'Astous, Stéphane Côté
This report describes a rare but life-threatening case of a suicide attempt initially considered as intentional overdose at the emergency department. Persistent altered mental status, despite normal toxicology investigations, led the attending team to order a head computed tomography scan, which revealed a bilateral penetrating nail gun injury with a right temporal hematoma for which a decompressive craniectomy was performed. Although voluntary intoxication is the most frequent form of suicide attempt, emergency physicians must be alert and maintain a broad differential diagnosis...
March 7, 2017: CJEM
https://www.readbyqxmd.com/read/28225374/characterizing-the-toxicity-and-dose-effect-profile-of-tramadol-ingestions-in-children
#4
Gina L Stassinos, Lawrence Gonzales, Wendy Klein-Schwartz
OBJECTIVES: Tramadol can cause life-threatening toxicity in overdose; however, data on its toxicity in children are lacking. This study investigates toxicity associated with tramadol ingestions in children. The hypothesis is that children will experience dose-related central nervous system and respiratory depression and seizures. METHODS: A retrospective evaluation of cases from the National Poison Center Data System between January 1, 2000, and December 31, 2013, was performed...
February 21, 2017: Pediatric Emergency Care
https://www.readbyqxmd.com/read/28215710/altered-mental-status-in-the-emergency-department-can-an-electrocardiogram-show-the-right-way-to-go
#5
Andre Dias, Emiliana Franco, Jasmine Martinez, Vincent M Figueredo
A 38-year-old African American male patient with a past medical history of human immunodeficiency virus and schizophrenia who was noncompliant with medications presented to the emergency department (ED) after activation of the local crisis response center for altered mental status. Upon arrival he was lethargic and uncooperative, unable to provide any significant details apart from pleuritic chest pain. His blood pressure was 133/88 mmHg, heart rate 43 beats per minute and initial body temperature 36.1 °C which prompted an electrocardiogram (EKG)...
February 2, 2017: Journal of Electrocardiology
https://www.readbyqxmd.com/read/28166446/use-of-intranasal-naloxone-by-basic-life-support-providers
#6
Scott G Weiner, Patricia M Mitchell, Elizabeth S Temin, Breanne K Langlois, K Sophia Dyer
STUDY OBJECTIVES: Intranasal delivery of naloxone to reverse the effects of opioid overdose by Advanced Life Support (ALS) providers has been studied in several prehospital settings. In 2006, in response to the increase in opioid-related overdoses, a special waiver from the state allowed administration of intranasal naloxone by Basic Life Support (BLS) providers in our city. This study aimed to determine: 1) if patients who received a 2-mg dose of nasal naloxone administered by BLS required repeat dosing while in the emergency department (ED), and 2) the disposition of these patients...
February 6, 2017: Prehospital Emergency Care
https://www.readbyqxmd.com/read/28159815/validation-of-the-prognostic-utility-of-the-electrocardiogram-for-acute-drug-overdose
#7
Alex F Manini, Ajith P Nair, Rajesh Vedanthan, David Vlahov, Robert S Hoffman
BACKGROUND: While it is certain that some emergency department patients with acute drug overdose suffer adverse cardiovascular events (ACVE), predicting ACVE is difficult. The prognostic utility of the ECG for heterogeneous drug overdose patients remains to be proven. This study was undertaken to validate previously derived features of the initial ECG associated with ACVE in this population. METHODS AND RESULTS: We performed a prospective validation cohort study to evaluate adult emergency department patients with acute drug overdose at 2 urban university hospitals over 5 years in whom an emergency department admission ECG was performed...
February 3, 2017: Journal of the American Heart Association
https://www.readbyqxmd.com/read/28151928/multiple-fentanyl-overdoses-new-haven-connecticut-june-23-2016
#8
Anthony J Tomassoni, Kathryn F Hawk, Karen Jubanyik, Daniel P Nogee, Thomas Durant, Kara L Lynch, Rushaben Patel, David Dinh, Andrew Ulrich, Gail D'Onofrio
On the evening of June 23, 2016, a white powder advertised as cocaine was purchased off the streets from multiple sources and used by an unknown number of persons in New Haven, Connecticut. During a period of less than 8 hours, 12 patients were brought to the emergency department (ED) at Yale New Haven Hospital, experiencing signs and symptoms consistent with opioid overdose. The route of intoxication was not known, but presumed to be insufflation ("snorting") in most cases. Some patients required doses of the opioid antidote naloxone exceeding 4 mg (usual initial dose = 0...
February 3, 2017: MMWR. Morbidity and Mortality Weekly Report
https://www.readbyqxmd.com/read/28148486/early-death-after-discharge-from-emergency-departments-analysis-of-national-us-insurance-claims-data
#9
Ziad Obermeyer, Brent Cohn, Michael Wilson, Anupam B Jena, David M Cutler
OBJECTIVE:  To measure incidence of early death after discharge from emergency departments, and explore potential sources of variation in risk by measurable aspects of hospitals and patients. DESIGN:  Retrospective cohort study. SETTING:  Claims data from the US Medicare program, covering visits to an emergency department, 2007-12. PARTICIPANTS:  Nationally representative 20% sample of Medicare fee for service beneficiaries...
February 1, 2017: BMJ: British Medical Journal
https://www.readbyqxmd.com/read/28123207/identifying-patients-for-overdose-prevention-with-icd-9-classification-in-the-emergency-department-massachusetts-2013-2014
#10
Jacqueline Ellison, Alexander Y Walley, James A Feldman, Edward Bernstein, Patricia M Mitchell, Elisa A Koppelman, Mari-Lynn Drainoni
The national rise in opioid overdose deaths signifies a need to integrate overdose prevention within healthcare delivery settings. The emergency department (ED) is an opportune location for such interventions. To effectively integrate prevention services, the target population must be clearly defined. We used ICD-9 discharge codes to establish and apply overdose risk categories to ED patients seen from January 1, 2013 to December 31, 2014 at an urban safety-net hospital in Massachusetts with the goal of informing ED-based naloxone rescue kit distribution programs...
September 2016: Public Health Reports
https://www.readbyqxmd.com/read/28122657/challenges-and-opportunities-to-engaging-emergency-medical-service-providers-in-substance-use-research-a-qualitative-study
#11
Allysha C Maragh-Bass, Julie C Fields, Junette McWilliams, Amy R Knowlton
Introduction Research suggests Emergency Medical Services (EMS) over-use in urban cities is partly due to substance users with limited access to medical/social services. Recent efforts to deliver brief, motivational messages to encourage these individuals to enter treatment have not considered EMS providers. Problem Little research has been done with EMS providers who serve substance-using patients. The EMS providers were interviewed about participating in a pilot program where they would be trained to screen their patients for substance abuse and encourage them to enter drug treatment...
January 26, 2017: Prehospital and Disaster Medicine
https://www.readbyqxmd.com/read/28111065/changes-in-provider-prescribing-patterns-after-implementation-of-an-emergency-department-prescription-opioid-policy
#12
Scott R Osborn, Julianna Yu, Barbara Williams, Maria Vasilyadis, C Craig Blackmore
BACKGROUND: Prescription opioid-associated abuse and overdose is a significant cause of morbidity and mortality in the United States. Opioid prescriptions generated from emergency departments (EDs) nationwide have increased dramatically over the past 20 years, and opioid-related overdose deaths have become an epidemic, according to the Centers for Disease Control and Prevention. OBJECTIVE: Our aim was to determine the effectiveness of implementing a prescription policy for opioids on overall opioid prescribing patterns in a hospital ED...
April 2017: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28100012/characterization-and-management-of-patients-with-heroin-versus-nonheroin-opioid-overdoses-experience-at-an-academic-medical-center
#13
Kate M Morizio, Regan A Baum, Adam Dugan, Julia E Martin, Abby M Bailey
STUDY OBJECTIVES: To characterize the differences between patients who had heroin and nonheroin opioid overdoses and to determine whether there were any significant differences in their management with regard to the naloxone use. DESIGN: Retrospective cohort study. SETTING: Large academic medical center. PATIENTS: A total of 923 patients admitted to the medical center who were identified for overdose by heroin or other opiate-related narcotics between January 2010 and September 2015; 480 patients experienced a nonheroin opioid overdose event, and 443 patients experienced a heroin overdose event...
January 18, 2017: Pharmacotherapy
https://www.readbyqxmd.com/read/28087496/digital-pills-to-measure-opioid-ingestion-patterns-in-emergency-department-patients-with-acute-fracture-pain-a-pilot-study
#14
Peter R Chai, Stephanie Carreiro, Brendan J Innes, Rochelle K Rosen, Conall O'Cleirigh, Kenneth H Mayer, Edward W Boyer
BACKGROUND: Nonadherence to prescribed regimens for opioid analgesic agents contributes to increasing opioid abuse and overdose death. Opioids are frequently prescribed on an as-needed basis, placing the responsibility to determine opioid dose and frequency with the patient. There is wide variability in physician prescribing patterns because of the lack of data describing how patients actually use as-needed opioid analgesics. Digital pill systems have a radiofrequency emitter that directly measures medication ingestion events, and they provide an opportunity to discover the dose, timing, and duration of opioid therapy...
January 13, 2017: Journal of Medical Internet Research
https://www.readbyqxmd.com/read/28064509/acute-salicylate-poisoning-risk-factors-for-severe-outcome
#15
Rachel M Shively, Robert S Hoffman, Alex F Manini
CONTEXT: Salicylate poisoning remains a significant public health threat with more than 20,000 exposures reported annually in the United States. OBJECTIVE: We aimed to establish early predictors of severe in-hospital outcomes in Emergency Department patients presenting with acute salicylate poisoning. METHODS: This was a secondary data analysis of adult salicylate overdoses from a prospective cohort study of acute drug overdoses at two urban university teaching hospitals from 2009 to 2013...
March 2017: Clinical Toxicology
https://www.readbyqxmd.com/read/28009694/can-emergency-department-hospital-discharge-and-death-data-be-used-to-monitor-burden-of-drug-overdose-in-rhode-island
#16
Yongwen Jiang, James V McDonald, Jennifer Koziol, Meghan McCormick, Samara Viner-Brown, Nicole Alexander-Scott
CONTEXT: Drug overdoses are a growing public health problem in the United States. Rhode Island is also confronted with a serious epidemic of drug overdose deaths and ranks sixth worst in the United States for age-adjusted drug overdose death rate. OBJECTIVE: To monitor trends of drug overdose-related emergency department (ED) visits, hospitalizations, and deaths and classify the drug overdoses by demographics, discharge status, intent, and specific drug involved to plan for health care resource allocation, mental health services, drug abuse treatment, prevention, and policies...
December 22, 2016: Journal of Public Health Management and Practice: JPHMP
https://www.readbyqxmd.com/read/27979642/severe-carisoprodol-withdrawal-after-a-14-year-addiction-and-acute-overdose
#17
Kathy T Vo, Howard Horng, Craig G Smollin, Neal L Benowitz
BACKGROUND: Carisoprodol, a centrally acting muscle relaxant with a high abuse potential, has barbiturate-like properties at the GABA-A receptor, leading to central nervous system depression and desired effects. Its tolerance and dependence has been previously demonstrated in an animal model, and withdrawal has been described in several recent case reports. Many cases can be effectively managed with a short course of benzodiazepines or antipsychotic agents. However, abrupt cessation in a patient with a history of long-term and high-dose carisoprodol abuse may result in symptoms that are more difficult for providers to treat...
December 12, 2016: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/27959295/intravenous-lipid-emulsion-for-management-of-systemic-toxic-effects-of-drugs
#18
Jaclyn O'Connor, Suprat Saely Wilson
The incidence of toxic effects of drugs leading to emergency department visits has increased in the United States in the past several years. Most of these patients can be adequately managed by supportive care alone. However, pharmacological antidotes may be necessary, particularly in patients with hemodynamic instability. In severe cases refractory to conventional antidote therapy, rescue therapy with intravenous lipid emulsion (ILE) may be necessary. Traditionally, ILE has been used as an antidote of choice in treating toxic effects of local anesthetics...
October 2016: AACN Advanced Critical Care
https://www.readbyqxmd.com/read/27923527/benzodiazepine-opioid-co-prescribing-in-a-national-probability-sample-of-emergency-department-encounters
#19
Howard S Kim, Danielle M McCarthy, D Mark Courtney, Patrick M Lank, Bruce L Lambert
BACKGROUND: Benzodiazepine-opioid combination therapy is potentially harmful due to the risk of synergistic respiratory depression, and the rate of death due to benzodiazepine-opioid overdose is increasing. Little is known about the prevalence and characteristics of benzodiazepine-opioid co-prescribing from the ED setting. METHODS: Secondary analysis of data from the National Hospital Ambulatory Medical Care Survey, using sample weights to generate population estimates...
December 2, 2016: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/27917218/can-we-predict-agitation-in-patients-with-suicide-attempts-in-the-emergency-department
#20
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
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