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https://www.readbyqxmd.com/read/29331270/severe-beta-blocker-and-calcium-channel-blocker-overdose-role-of-high-dose-insulin
#1
Karan Seegobin, Satish Maharaj, Ansuya Deosaran, Pramod Reddy
A 54-year-old female presented after taking an overdose of an unknown amount of hydrochlorothiazide, doxazocin, atenolol and amlodipine. She was initially refractory to treatment with conventional therapy (intravenous fluids, activated charcoal, glucagon 5 mg followed with glucagon drip, calcium gluconate 10%, and atropine). Furthermore, insulin at 4 U/kg was not effective in improving her hemodynamics. Shortly after high dose insulin was achieved with 10 U/kg, there was dramatic improvement in hemodynamics resulting in three of five vasopressors being weaned off in 8 h...
January 10, 2018: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29299212/risk-factors-of-mortality-due-to-acute-opium-poisoning-a-report-from-the-largest-intoxication-referral-center-in-iran
#2
Sahar Rismantab-Sani, Babak Soltani, Siamak Soltani, Azadeh Memarian
Background: Studies have shown that Iran has a high rate of opiate abuse and the most prevalently used is opium. This study was aimed to evaluate risk factors in patients with acute opium intoxication who referred to Loghman Hakim Hospital, Tehran, Iran, in 2011. Methods: A total number of 383 patients with acute opium overdose, who were referred to the Emergency Department of Loghman Hakim Hospital in Tehran during 2011, were enrolled into this descriptive, cross-sectional study...
April 2017: Addiction & Health
https://www.readbyqxmd.com/read/29295971/special-k-with-no-license-to-kill-accidental-ketamine-overdose-on-induction-of-general-anesthesia
#3
Lindsay L Warner, Nathan Smischney
BACKGROUND Ketamine is used as an induction and sedation agent in emergency departments and operating rooms throughout the country. Despite its widespread clinical use, there are few cases of significant morbidity and mortality attributed to ketamine overdose in the clinical setting. CASE REPORT The anesthesia provider in the room was an oral maxillofacial surgeon who inadvertently took out a more highly concentrated bottle of ketamine that is typically used for pediatric patients. The patient received 950 mg (100 mg/ml concentration) of intravenous ketamine instead of the intended 95 mg (10 mg/ml concentration)...
January 3, 2018: American Journal of Case Reports
https://www.readbyqxmd.com/read/29290509/ambient-mass-spectrometry-for-rapid-diagnosis-of-psychoactive-drugs-overdose-in-an-unstable-patient
#4
Chi-Wei Lee, Yu-Ying Chao, Jentaie Shiea, Jheng-Heng Shen, Hei-Hwa Lee, Bai-Hsiun Chen
A 25-year-old man suffered from consciousness change was sent to our emergency department by friends who reported that they were not sure what had happened to him. Physical examination revealed bilateral pupils dilatation, lethargy, slurred speech, and ataxia. Computer-aided tomographic scan of the brain revealed no definite evidence of intracranial lesions. Routine laboratory tests revealed total physiological turmoil. Despite immediate commencement of aggressive treatment, the patient's condition deteriorated long before the traditional drug screen provided an answer for the identities of the multiple drugs overdose...
December 20, 2017: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29241835/the-impact-of-a-statewide-mandatory-prescription-drug-monitoring-program-on-opioid-prescribing-by-emergency-medicine-providers-across-15-hospitals-in-a-single-health-system
#5
Brian Suffoletto, Michael Lynch, Charissa B Pacella, Donald M Yealy, Clifton W Callaway
Prescription drug monitoring programs (PDMP) enable registered prescribers to obtain real-time information on patients' prescription history of controlled medications. We sought to describe the impact of a state-mandated PDMP on opioid prescribing by Emergency Medicine providers. We retrospectively analyzed electronic medical records of 122,732 adult patients discharged with an opioid prescription from 15 Emergency Departments in a single health system in Pennsylvania from July 2015 to March, 2017. We used an interrupted time-series design to evaluate the percentage of patients discharged each month with an opioid prescription before and after state law mandated PDMP use on August 25th, 2016...
December 11, 2017: Journal of Pain: Official Journal of the American Pain Society
https://www.readbyqxmd.com/read/29198490/overdose-and-adverse-drug-event-experiences-among-adult-patients-in-the-emergency-department
#6
Amy S B Bohnert, Maureen A Walton, Rebecca M Cunningham, Mark A Ilgen, Kristen Barry, Stephen T Chermack, Frederic C Blow
INTRODUCTION: Overdose is a leading cause of injury and death in the United States. Emergency Department (ED) patients have an elevated prevalence of substance use. This study describes overdose/adverse drug event experiences among adult ED patients to inform strategies to address overdose risk. METHODS: Patients seeking care at a large ED in the city of Flint, Michigan participated in a computerized self-assessment during 2011-2013 (n=4571). Overdose was assessed with a broad definition and included occurrences that could be considered adverse drug events...
November 16, 2017: Addictive Behaviors
https://www.readbyqxmd.com/read/29183241/alcohol-involvement-in-suicide-and-self-harm
#7
Celine Larkin, Eve Griffin, Paul Corcoran, Carmel McAuliffe, Ivan J Perry, Ella Arensman
BACKGROUND: Alcohol misuse and alcohol consumption are significant risk factors for suicidal behavior. AIMS: This study sought to identify factors associated with alcohol consumption in cases of suicide and nonfatal self-harm presentations. METHOD: Suicide cases in Cork, Ireland, from September 2008 to June 2012 were identified through the Suicide Support and Information System. Emergency department presentations of self-harm in the years 2007-2013 were obtained from the National Self-Harm Registry Ireland...
November 29, 2017: Crisis
https://www.readbyqxmd.com/read/29178371/insulin-degludec-overdose-may-lead-to-long-lasting-hypoglycaemia-through-its-markedly-prolonged-half-life
#8
J Uchida, Y Oikawa, T Katsuki, H Takeda, A Shimada, T Kawai
BACKGROUND: Overdose of insulin often causes long-lasting severe hypoglycaemia. Insulin degludec has the longest duration of action among the available insulin products; thus, an overdose of insulin degludec can lead to long-lasting hypoglycaemia. In the present paper, we report the case of a woman with long-lasting hypoglycaemia attributable to insulin degludec overdose and markedly prolonged insulin degludec half-life. CASE REPORT: A 64-year-old woman with Type 2 diabetes receiving insulin therapy was taken to an emergency department because of disturbed consciousness 21 h after self-injection of 300 units of insulin degludec (4...
November 27, 2017: Diabetic Medicine: a Journal of the British Diabetic Association
https://www.readbyqxmd.com/read/29174833/does-prescription-opioid-shopping-increase-overdose-rates-in-medicaid-beneficiaries
#9
Benjamin C Sun, Nicoleta Lupulescu-Mann, Christina J Charlesworth, Hyunjee Kim, Daniel M Hartung, Richard A Deyo, K John McConnell
STUDY OBJECTIVE: The link between prescription opioid shopping and overdose events is poorly understood. We test the hypothesis that a history of prescription opioid shopping is associated with increased risk of overdose events. METHODS: This is a secondary analysis of a linked claims and controlled substance dispense database. We studied adult Medicaid beneficiaries in 2014 with prescription opioid use in the 6 months before an ambulatory care or emergency department visit with a pain-related diagnosis...
November 23, 2017: Annals of Emergency Medicine
https://www.readbyqxmd.com/read/29170334/37%C3%A2-routine-testing-of-salicylate-levels-in-overdose-patients-still-needed
#10
Elaine Hardy, Clare Toro, Susan Dorrian, Umesh Salanke
INTRODUCTION AND AIMS: Overdose is a common presentation in Emergency Departments (EDs) across the UK. Salicylate poisoning is potentially fatal; however it is becoming increasingly uncommon in the UK. This may be due to restriction of pack sizes in over the counter medicines as well as the use of aspirin as an analgesic being superseded by other NSAIDs, particularly ibuprofen.In conjunction with clinical features of salicylate toxicity, measurement of plasma salicylate concentration can help guide management...
December 2017: Emergency Medicine Journal: EMJ
https://www.readbyqxmd.com/read/29146420/extracorporeal-membrane-oxygenation-used-successfully-in-a-near-fatal-case-of-opioid-induced-acute-respiratory-distress-syndrome
#11
Karen Greenberg, Benjamin Kohl
Acute Respiratory Distress Syndrome (ARDS) was first recognized during the 1960s. It is a distinct type of hypoxemic respiratory failure characterized by acute abnormality of both lungs. Extracorporeal membrane oxygenation (ECMO) is being increasingly used for patients with severe ARDS refractory to otherwise conventional management. A 29year old male arrived with Emergency Medical Services (EMS) status post presumed heroin overdose. He was administered Naloxone 2mg intravenously prior to arrival in the emergency department...
November 8, 2017: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29132953/emergency-department-visits-involving-opioid-overdoses-u-s-2010-2014
#12
Gery P Guy, Emilia Pasalic, Kun Zhang
No abstract text is available yet for this article.
November 10, 2017: American Journal of Preventive Medicine
https://www.readbyqxmd.com/read/29129552/clinical-characteristics-of-suicidal-behavior-in-an-intensive-care-unit-at-a-university-hospital-in-japan-a-7-year-observational-study
#13
Takashi Takeuchi, Yasuyuki Okumura, Akihito Uezato, Toru Nishikawa
BACKGROUND: Suicidal behavior accounts for at least 40,000 admissions per year to emergency departments in Japan; however, little is known about emergency admissions owing to suicidal behavior in metropolitan areas. Therefore, we examined the clinical characteristics of suicidal behavior using psychosocial assessments performed by experienced psychiatrists in an intensive care unit. METHODS: Participants were 971 patients admitted to a university hospital's intensive care unit for suicidal behavior between July 2006 and June 2013...
November 7, 2017: Asian Journal of Psychiatry
https://www.readbyqxmd.com/read/29128677/macroeconomic-conditions-and-opioid-abuse
#14
Alex Hollingsworth, Christopher J Ruhm, Kosali Simon
We examine how deaths and emergency department (ED) visits related to use of opioid analgesics (opioids) and other drugs vary with macroeconomic conditions. As the county unemployment rate increases by one percentage point, the opioid death rate per 100,000 rises by 0.19 (3.6%) and the opioid overdose ED visit rate per 100,000 increases by 0.95 (7.0%). Macroeconomic shocks also increase the overall drug death rate, but this increase is driven by rising opioid deaths. Our findings hold when performing a state-level analysis, rather than county-level; are primarily driven by adverse events among whites; and are stable across time periods...
December 2017: Journal of Health Economics
https://www.readbyqxmd.com/read/29127600/a-review-of-current-and-emerging-approaches-to-pain-management-in-the-emergency-department
#15
REVIEW
Knox H Todd
INTRODUCTION: Pain is the most common symptom prompting an emergency department visit and emergency physicians are responsible for managing both acute pain and acute exacerbations of chronic pain resulting from a broad range of illnesses and injuries. The responsibility to treat must be balanced by the duty to limit harm resulting from analgesics. In recent years, opioid-related adverse effects, including overdose and deaths, have increased dramatically in the USA. In response to the US opioid crisis, emergency physicians have broadened their analgesic armamentarium to include a variety of non-opioid approaches...
December 2017: Pain and Therapy
https://www.readbyqxmd.com/read/29123931/rapid-ascending-sensorimotor-paralysis-hearing-loss-and-fatal-arrhythmia-in-a-multimorbid-patient-due-to-an-accidental-overdose-of-fluoxetine
#16
Matthew Herrmann, Prissilla Xu, Antonio Liu
Background: Common side effects of selective serotonin reuptake inhibitors (SSRIs) include tachycardia, drowsiness, tremor, nausea, and vomiting. Although SSRIs have less toxic side effects compared to more traditional antidepressants, serious and life threatening cases of SSRI overdose have been reported. We describe a 24-year-old multimorbid female who presented to the emergency department with rapid onset ascending sensorimotor paralysis, complicated by respiratory and cardiac arrest, found to have fatal levels of fluoxetine by toxicological analysis, not taken in a suicidal act...
2017: Case Reports in Neurological Medicine
https://www.readbyqxmd.com/read/29121560/evaluation-of-attempted-older-adults-suicides-admitted-to-a-university-hospital-emergency-department-izmir-study
#17
Duygu Keskin Gokcelli, Pınar Tosun Tasar, Nur Ozge Akcam, Sevnaz Sahin, Funda Karbek Akarca, Ekin Ozgur Aktas, Soner Duman, Fehmi Akcicek, Aysin Noyan
INTRODUCTION: Advanced age is one of the risk factors for attempting suicide. Suicide attempts are one of the reasons for elderly patients to admit emergency services. The aim of this study was to investigate the relationship between suicidal behavior and sociodemographic factors and concurrent somatic diseases. METHODS: The medical records of patients aged 60 years and over who presented to the emergency department of our university hospital for attempted suicide between the dates of January 1, 2007 and December 31, 2015 were screened retrospectively...
October 16, 2017: Asian Journal of Psychiatry
https://www.readbyqxmd.com/read/29118840/too-many-pills-to-swallow-a-case-of-a-mixed-overdose
#18
Louise Emily Hopkins, Jonathan Sunkersing, Andrew Jacques
Propranolol is a highly lipid-soluble beta-receptor antagonist. We describe a case of mixed overdose, including propranolol, amlodipine and olanzapine, resulting in severe resistant hypotension which was successfully treated. A 21-year-old student ingested 6.4 g of propranolol, 280 mg of amlodipine and 560 mg of olanzapine. The patient was brought to the emergency department and exhibited signs of severe systemic toxicity - profound hypotension and circulatory collapse, respiratory depression and coma...
August 2017: Journal of the Intensive Care Society
https://www.readbyqxmd.com/read/29113574/a-novel-sexual-health-referral-pathway-for-patients-presenting-to-the-emergency-department-with-gamma-hydroxybutyrate-or-gamma-butyrolactone-overdose
#19
A Hegazi, S Morton, M Pakianathan, C Cosgrove, R Aroney, E Dore, M Hempling
No abstract text is available yet for this article.
December 2017: International Journal of STD & AIDS
https://www.readbyqxmd.com/read/29107318/a-quality-improvement-project-to-improve-education-provided-by-nurses-to-ed-patients-prescribed-opioid-analgesics-at-discharge
#20
Daria L Waszak, Ann M Mitchell, Dianxu Ren, Laura A Fennimore
BACKGROUND: The opioid crisis continues to take an unprecedented number of lives and is the top cause of injury death in the United States. The emergency department is a setting where patients with pain seek care and may be prescribed an opioid, yet many patients do not receive evidence-based education about taking their opioid safely. Like many communities across the country, Allegheny County, Pennsylvania, has experienced an increased rate of opioid overdoses; from 2015-2016, the number of opioid-related overdose deaths in the county increased by 44%...
October 26, 2017: Journal of Emergency Nursing: JEN: Official Publication of the Emergency Department Nurses Association
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