Annals of emergency medicine
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To describe the clinical characteristics and course of gamma-hydroxybutyrate (GHB) overdose. ⋯ In our study population, patients who overdosed on GHB presented with a markedly decreased level of consciousness. Coingestion of ethanol or other drugs is common, as are bradycardia, hypothermia, respiratory acidosis, and emesis. Hypotension occurs occasionally. Patients typically regain consciousness spontaneously within 5 hours of the ingestion.
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γ-Hydroxybutyric acid (GHB) is unfamiliar to many physicians in the United States but enjoys clinical use elsewhere for applications in resuscitation, anesthesia, and addiction therapy. Use within the United States is restricted to Food and Drug Administration- approved clinical trials for treatment of narcolepsy. Recently illicit use of GHB has emerged within the United States where it is distributed for purported euphoric and "fat-burning" metabolic effects. ⋯ Recommended management of acute GHB intoxication includes prevention of aspiration, use of atropine for persistent symptomatic bradycardia, consideration of neostigmine as a reversal agent, and treatment for coingested substances. Emergency physicians are urged to become familiar with GHB because of its potential for severe morbidity, as well as its potential use as a future resuscitative agent. [Li J, Stokes SA, Woeckener A: A tale of novel intoxication: A review of the effects of γ-hydroxybutyric acid with recommendations for management. Ann Emerg Med June 1998;31:729-736.].
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Case Reports
Intramuscular ketamine for pediatric sedation in the emergency department: safety profile in 1,022 cases.
To determine the safety of intramuscular ketamine when administered by emergency physicians for pediatric procedures in accordance with a defined protocol. ⋯ Intramuscular ketamine may be administered safely by emergency physicians to facilitate pediatric procedures in accordance with a defined protocol and with appropriate monitoring. Ketamine is highly effective, has a wide margin of safety, does not require intravenous access, and uniquely preserves protective airway reflexes.
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To describe a community's experience with the use of emergency department services by nursing home residents. ⋯ Elders living in nursing homes are frequently transferred to EDs for costly medical evaluations, and more than 40% of such visits lead to admission to the hospital.
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This is the first report to describe the delayed onset of hypoglycemia in a child after ingestion of one tablet of glipizide. A 2-year-old boy was observed to ingest 5 mg glipizide and 25 mg hydrochlorothiazide. ⋯ Emergency physicians must be aware of the potential for delayed hypoglycemia in children with single-tablet ingestions of glipizide. Prolonged monitoring of glucose levels is warranted.