The American journal of emergency medicine
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To describe the chronotoxicology of cocaine and its potential impact on emergency department (ED) staffing and services, Drug Abuse Warning Network (DAWN) data from a single urban university ED were retrospectively reviewed. The DAWN data reviewed spanned an 11-year period (1/1/83 through 12/31/93), and 3,762 patients were enrolled. Patients were included if the ED records included documentation of recent cocaine abuse prior to presentation to the ED. ⋯ For all patients using cocaine, there were two significant rhythms (P < .05) identified: a circadian rhythm that peaked at 1800 and a 12-hour rhythm that peaked at approximately noon and midnight. A significant rhythmicity was found among cocaine-using patients who presented during the study period. Increased or shift-adjusted staffing focusing specifically on psychosocial services, detoxification, and security during these peak hours may provide more efficient emergent care for this subpopulation of patients.
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Immediate cardiac arrest may occur as a result of the physiological consequences of critical airway management, which may include one or all of the following: (1) sedation and/or paralysis, (2) tracheal intubation, and (3) positive pressure ventilation. Two patients are reported, both with myocarditis, who developed cardiac arrest within minutes of simple intubations. Their arrests were not related to technical difficulties of critical airway management. ⋯ This may be a significant mechanism through which immediate decompensation occurs. Potential conditions that cause preload-dependent cardiovascular systems, as well as alternate therapeutic considerations, are outlined. In these patients intubations should not be delayed, but should be done with extreme caution in anticipation of possible cardiac arrest.
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Letter Case Reports
Vertebral artery dissection following chiropractic manipulation.