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https://www.readbyqxmd.com/read/28920564/intentional-overdose-of-the-novel-anti-epileptic-drug-eslicarbazepine-presenting-with-recurrent-seizures-and-ventricular-dysrhythmias
#1
Jesse Thompson, James D Powell, Daniel H Ovakim
Eslicarbazepine is a novel anti-epileptic agent indicated for the treatment of partial-onset seizures. We present the case of an 18 year old female that presented to the Emergency Department four hours after a reported intentional ingestion of an estimated 5600 mg of eslicarbazepine. Although initially hemodynamically stable and neurologically normal, shortly after arrival she developed confusion, rigidity and clonus, followed by recurrent seizures, hypoxemia and cardiac arrest which responded to cardiopulmonary resuscitation and wide complex tachycardia requiring defibrillation...
September 18, 2017: CJEM
https://www.readbyqxmd.com/read/28918769/emergency-physicians-attitudes-and-perceived-barriers-to-the-implementation-of-take-home-naloxone-programs-in-canadian-emergency-departments
#2
Lauren Lacroix, Lisa Thurgur, Aaron M Orkin, Jeffrey J Perry, Ian G Stiell
OBJECTIVES: Rates of opioid-related deaths have reached the level of national public health crisis in Canada. Community-based opioid overdose education and naloxone distribution (OEND) programs distribute naloxone to people at risk, and the emergency department (ED) may be an underutilized setting to deliver naloxone to these people. The goal of this study was to identify Canadian emergency physicians' attitudes and perceived barriers to the implementation of take-home naloxone programs...
September 18, 2017: CJEM
https://www.readbyqxmd.com/read/28883749/student-selected-component-in-the-medical-curriculum-investigations-and-psychiatric-referral-for-paracetamol-overdose-in-an-accident-and-emergency-department
#3
James G Cowman, Manuel Bakheet
BACKGROUND: A student-selected component (SSC) of the medical curriculum requires the student to be self-directed in locating and undertaking a placement in a clinical specialty of their choosing and completing a project. The clinical area for experience was an accident and emergency department, and our topic was a focused audit on the investigations and referral for paracetamol overdose. The purpose of this paper is twofold: to reflect on the education value to medical students of an SSC in a medical curriculum, and to highlight learning and understanding through completion of an audit...
2017: Advances in Medical Education and Practice
https://www.readbyqxmd.com/read/28874942/effect-of-a-no-superuser-opioid-prescription-policy-on-ed-visits-and-statewide-opioid-prescription
#4
Zachary P Kahler, Paul I Musey, Jason T Schaffer, Annelyssa N Johnson, Christian C Strachan, Charles M Shufflebarger
INTRODUCTION: The U.S. opioid epidemic has highlighted the need to identify patients at risk of opioid abuse and overdose. We initiated a novel emergency department- (ED) based interventional protocol to transition our superuser patients from the ED to an outpatient chronic pain program. The objective was to evaluate the protocol's effect on superusers' annual ED visits. Secondary outcomes included a quantitative evaluation of statewide opioid prescriptions for these patients, unique prescribers of controlled substances, and ancillary testing...
August 2017: Western Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28873050/randomized-pilot-trial-measuring-knowledge-acquisition-of-opioid-education-in-emergency-department-patients-using-a-novel-media-platform
#5
Bharath Chakravarthy, Shashank Somasundaram, Jennifer Mogi, Roshan Burns, Wirachin Hoonpongsimanont, Warren Wiechmann, Shahram Lotfipour
BACKGROUND: The number of active opioid analgesic prescriptions has risen steadily causing increases in nonmedical opioid use, addiction and overdose. Insufficient focus on patient discharge instructions has contributed to lack of patient awareness regarding dangers of opioids. We examine whether an educational Khan Academy-styled animation discharge instruction on the dangers and safe usage of opioid analgesics elicits higher knowledge acquisition than current standard of care. Additionally, we measure the feasibility of implementing this video discharge instruction in the emergency department (ED)...
September 5, 2017: Substance Abuse
https://www.readbyqxmd.com/read/28871560/oesophageal-coins-invisible-on-chest-radiography-a-case-report
#6
Jin Takahashi, Takashi Shiga, Hiraku Funakoshi
BACKGROUND: Coins are made of metal, which is generally radiopaque, and so physicians often have the misconception that all coins are detectable by radiography. Here, we report a case of intentionally swallowed coins in the oesophagus of an adult; the coins could not be detected on chest radiography but were detected using computed tomography (CT). CASE PRESENTATION: A 46-year-old woman with a history of depression presented to the emergency department after an intentional medication overdose and ingestion of two Japanese 1-yen coins...
September 5, 2017: International Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28860892/patterns-of-health-care-utilization-and-cost-before-and-after-opioid-overdose-findings-from-10-year-longitudinal-health-plan-claims-data
#7
Daniel D Maeng, John J Han, Michael H Fitzpatrick, Joseph A Boscarino
OBJECTIVE: To describe the longitudinal pattern of health care utilization and cost of care before and after opioid overdose (OD) over a 10-year period using health plan claims data. METHODS: Patients who had experienced opioid ODs between April 2005 and March 2015 were identified from Geisinger Health System's electronic health records. Among these patients, a subgroup of patients who were Geisinger Health Plan (GHP) members at any point between January 2006 and December 2015 were also identified...
2017: Substance Abuse and Rehabilitation
https://www.readbyqxmd.com/read/28855066/emergency-department-approach-to-qtc-prolongation
#8
REVIEW
Ali Pourmand, Maryann Mazer-Amirshahi, Sonya Chistov, Youssef Sabha, Damir Vukomanovic, Mohammed Almulhim
QTc prolongation has been associated with increased risk of developing ventricular tachydysrhythmias, particularly Torsades de Pointes (TdP). QTc prolongation is influenced by many factors including congenital causes, heart rate, metabolic imbalances, and pharmacotherapy. Several commonly used medications in the emergency department (ED), such as antipsychotics and antiemetics, are known to prolong the QT interval. In addition, ED patients may present with conditions that may predispose them to QTc prolongation, such as drug overdose or hypokalemia, which can further complicate management...
August 24, 2017: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28835443/a-statewide-evaluation-of-seven-strategies-to-reduce-opioid-overdose-in-north-carolina
#9
Apostolos A Alexandridis, Agnieszka McCort, Christopher L Ringwalt, Nidhi Sachdeva, Catherine Sanford, Stephen W Marshall, Karin Mack, Nabarun Dasgupta
BACKGROUND: In response to increasing opioid overdoses, US prevention efforts have focused on prescriber education and supply, demand and harm reduction strategies. Limited evidence informs which interventions are effective. We evaluated Project Lazarus, a centralised statewide intervention designed to prevent opioid overdose. METHODS: Observational intervention study of seven strategies. 74 of 100 North Carolina counties implemented the intervention. Dichotomous variables were constructed for each strategy by county-month...
August 23, 2017: Injury Prevention: Journal of the International Society for Child and Adolescent Injury Prevention
https://www.readbyqxmd.com/read/28812394/the-use-of-sustained-low-efficiency-dialysis-sled-in-massive-paracetamol-overdose
#10
Anselm Wong, Roger L K Tong, Liam Ryan, Tim Crozier, Andis Graudins
CONTEXT: Massive paracetamol ingestion causing mitochondrial dysfunction is uncommon. Use of sustained low-efficiency dialysis (SLED) to improve acidaemia and enhance paracetamol elimination has not been previously described. CASE DETAILS: A 44-year-old male presented to the emergency department 2.5 hours post overdose of 200 g (2.5 g/kg) of paracetamol. Examination revealed a BP 85/60 mmHg, pulse 112 bpm, temperature 33.9 °C and blood glucose of 13...
August 16, 2017: Clinical Toxicology
https://www.readbyqxmd.com/read/28810127/medicaid-prior-authorization-and-opioid-medication-abuse-and-overdose
#11
Gerald Cochran, Adam J Gordon, Walid F Gellad, Chung-Chou H Chang, Wei-Hsuan Lo-Ciganic, Carroline Lobo, Evan Cole, Winfred Frazier, Ping Zheng, David Kelley, Julie M Donohue
OBJECTIVES: The US opioid medication epidemic has resulted in serious health consequences for patients. Formulary management tools adopted by payers, specifically prior authorization (PA) policies, may lower the rates of opioid medication abuse and overdose. We compared rates of opioid abuse and overdose among enrollees in plans that varied in their use of PA from "High PA" (ie, required PA for 17 to 74 opioids), with "Low PA" (ie, required PA for 1 opioid), and "No PA" policies for opioid medications...
May 1, 2017: American Journal of Managed Care
https://www.readbyqxmd.com/read/28791786/emergency-department-provider-perspectives-on-benzodiazepine-opioid-co-prescribing-a-qualitative-study
#12
Howard S Kim, Danielle M McCarthy, Jason A Hoppe, D Mark Courtney, Bruce L Lambert
OBJECTIVE: Benzodiazepines and opioids are prescribed simultaneously (i.e. "co-prescribed") in many clinical settings, despite guidelines advising against this practice and mounting evidence that concomitant use of both medications increases overdose risk. This study sought to characterize the contexts in which benzodiazepine-opioid co-prescribing occurs and providers' reasons for co-prescribing. METHODS: We conducted focus groups with ED providers (resident and attending physicians, advanced practice providers, and pharmacists) from three hospitals using semi-structured interviews to elicit perspectives on benzodiazepine-opioid co-prescribing...
August 9, 2017: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/28764574/designer-drugs-review-and-implications-for-emergency-management
#13
A Pourmand, M Mazer-Amirshahi, S Chistov, A Li, M Park
In the past 10 years, "designer drugs" such as synthetic cannabinoids and cathinones have emerged and come into widespread use, resulting in more overdose cases involving these new drugs in the United States. Emergency departments regularly treat a diverse array of drug intoxications, and providers must be cognizant of novel drugs of abuse and the associated clinical presentations in order to provide the most appropriate care. This review aims to describe the epidemiology, mechanism of action, clinical presentation, and treatment of intoxication for both the common and newest drugs of abuse...
January 1, 2017: Human & Experimental Toxicology
https://www.readbyqxmd.com/read/28756679/accuracy-of-the-paracetamol-aminotransferase-product-to-predict-hepatotoxicity-in-paracetamol-overdose-treated-with-a-2-bag-acetylcysteine-regimen
#14
Anselm Wong, Marco L A Sivilotti, Naren Gunja, Richard McNulty, Andis Graudins
INTRODUCTION: Paracetamol concentration is a highly accurate risk predictor for hepatotoxicity following overdose with known time of ingestion. However, the paracetamol-aminotransferase multiplication product can be used as a risk predictor independent of timing or ingestion type. Validated in patients treated with the traditional, "three-bag" intravenous acetylcysteine regimen, we evaluated the accuracy of the multiplication product in paracetamol overdose treated with a two-bag acetylcysteine regimen...
July 31, 2017: Clinical Toxicology
https://www.readbyqxmd.com/read/28735777/heroin-and-fentanyl-overdoses-in-kentucky-epidemiology-and-surveillance
#15
Svetla Slavova, Julia F Costich, Terry L Bunn, Huong Luu, Michael Singleton, Sarah L Hargrove, Jeremy S Triplett, Dana Quesinberry, William Ralston, Van Ingram
BACKGROUND: The study aims to describe recent changes in Kentucky's drug overdose trends related to increased heroin and fentanyl involvement, and to discuss future directions for improved drug overdose surveillance. METHODS: The study used multiple data sources (death certificates, postmortem toxicology results, emergency department [ED] records, law enforcement drug submissions, and prescription drug monitoring records) to describe temporal, geographic, and demographic changes in drug overdoses in Kentucky...
June 27, 2017: International Journal on Drug Policy
https://www.readbyqxmd.com/read/28734637/-asthma-and-heroin-use
#16
REVIEW
Michel Underner, Jean Perriot, Gérard Peiffer, Nematollah Jaafari
INTRODUCTION: Heroin use can be responsible for many respiratory complications including asthma. OBJECTIVES: Systematic literature review of data on asthma in heroin users. DOCUMENTARY SOURCES: Medline(®), on the period 1980-2017 with the following keywords: keywords: "asthma" or "bronchospasm" and "heroin" or "opiate" or "opiates", limits "title/abstract"; the selected languages were English or French. Among 97 articles, 67 abstracts have given use to a dual reading to select 23 studies...
July 2017: La Presse Médicale
https://www.readbyqxmd.com/read/28719481/opioid-prescribing-practices-in-pediatric-acute-care-settings
#17
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
#18
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...
September 2017: Forensic Science International
https://www.readbyqxmd.com/read/28705745/massive-diltiazem-and-metoprolol-overdose-rescued-with-extracorporeal-life-support
#19
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
#20
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
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