Emergency medicine clinics of North America
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Newer drugs of abuse, such as MDMA, GHB, GBL, 1,4-BD and ketamine, are frequently used in the settings of raves and are often promoted on the internet. The popularity of these agents is increasing; therefore, emergency physicians should become familiar with the clinical presentations and management of the toxicity induced by these agents.
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Emerg. Med. Clin. North Am. · Nov 2000
ReviewPharmacology of emergency department pain management and conscious sedation.
The endpoints of sedation and analgesia have been more difficult than traditional physiologic parameters to measure adequately. Several clinical scoring systems have been developed in an attempt to provide more consistent and objective assessments of sedation, but the few that have been validated are cumbersome to use in the clinical setting and cannot accurately determine subtle changes in the level of sedation. Recent developments in EEG monitoring, particularly one using bispectral (BIS) analysis of the EEG signal obtained through a noninvasive forehead "lead," are promising. ⋯ Anesthesiologists have used this technology to prevent awareness during paralysis. One recently completed but as yet unpublished study in the ED demonstrated a high correlation with traditional sedation scales and found the device easy to use (UNC Hospitals Department of Emergency Medicine, personal communication, 1999). It is anticipated that with BIS monitoring, in combination with titratable, short-acting agents, appropriate levels of sedation can be more easily achieved while minimizing associated complications and duration of ED stay.
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Emerg. Med. Clin. North Am. · Nov 2000
ReviewAntidepressants, old and new. A review of their adverse effects and toxicity in overdose.
The newer antidepressants are as efficacious as the older agents in the treatment of depression. They have a side effect profile that is different from the older drugs and are generally better tolerated. Drug-drug interactions do exist with some of these agents and can usually be predicted from knowledge of their metabolism. ⋯ The serotonin syndrome can occur with many of these drugs, and the emergency physician must be vigilant in the evaluation of the overdose patient. CAs and older MAOIs are still in use and remain dangerous when taken in overdose. Patients asymptomatic after a period of observation in the ED usually can be discharged after psychiatric evaluation, when it is required.
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Emerg. Med. Clin. North Am. · Nov 2000
ReviewAdvances in airway pharmacology. Emerging trends and evolving controversy.
The practice of emergency medicine is a constant onslaught of decision making and challenges and the issues of airway management are no exception. Obtaining proper airway control requires thoughtful organization and planning, and necessitates a thorough working knowledge of the drugs or medications employed. Because there are so many agents available, expertise in airway pharmacology has become essential. The emergency physician who is well versed in the uses, and the physiologic effects, contraindications, and alternatives of drugs administered is both providing immediate intervention and positively affecting patient outcome, which is certainly a goal worth achieving.