The American journal of emergency medicine
-
Case Reports
Management of a severe carbamazepine overdose with continuous venovenous hemodiafiltration.
Carbamazepine (CBZ) is a commonly used antiepileptic agent. Common toxic effects include neurological abnormalities; ataxia, seizures, coma, cardiorespiratory problems; dysrhythmias; conduction disorders; respiratory depression; and eye abnormalities, such as nystagmus and ophthalmoplegia. Carbamazepine is highly protein bound. ⋯ Supportive measures and charcoal hemoperfusion have been regarded as efficient treatment methods. We herein report a 17-year old girl to whom continuous venovenous hemodiafiltration lacking the albumin-enhance after suicidal overdose of CBZ was performed. We suggest continuous venovenous hemodiafiltration lacking the albumin-enhance as an alternative emergency treatment modality for cases who had ingested CBZ in toxic levels.
-
Brugada syndrome is characterized by the electrocardiographic (ECG) pattern of right bundle-branch block (RBBB) with a high take-off, coved ST-segment elevation in the precordial leads V1 to V3, and the risk of sudden cardiac death. Typically, there is no evidence of structural heart disease. In many cases, Brugada syndrome has been linked to a mutation of the gene SCN5A, which encodes for the fast cardiac sodium channel. ⋯ Interestingly, even in patients with a normal baseline ECG and no clinical suggestion of the Brugada syndrome, toxic doses of class I antiarrhythmic agents as well as toxicities with several nonantiarrhythmic drugs that possess sodium channel blocking properties can induce the Brugada ECG abnormality. Specifically, the beta-receptor blocker propranolol, at high doses, binds to the cardiac sodium channels and inhibits sodium uptake. In this report, we describe a case of severe propranolol toxicity, which resulted in the Brugada ECG pattern in an otherwise healthy individual who had no clinical or ECG suggestion of the genetically determined Brugada syndrome.
-
The study aimed to assess, in pediatric patients presenting to the emergency department (ED), the incidence of visit to the ED for functional constipation (FC), symptoms, signs of presentation, and management from ED physicians. ⋯ Emergency department physicians have an important role in the diagnosis and management of FC despite its relatively low incidence. Indeed, ED intervention in many cases leads not only to recognition this disease but also to an approach for therapeutic strategy, avoiding complications of chronic constipation.
-
Therapeutic hypothermia has been reported to improve the neurologic outcome of comatose survivors of out-of-hospital cardiac arrest. The use of therapeutic hypothermia in patients who have had an acute ischemic-hypoxic brain injury after a suicidal intoxication has not been previously reported. We present the case of a young woman who presented comatose to our emergency department after attempting suicide by ingesting diazepam and a bottle of antifreeze (ethylene-glycol). ⋯ The patient awoke within 48 hours of rewarming and made a complete and full neurologic recovery. In conclusion, this case has important implications in the management of patients who have had an acute ischemichypoxic brain injury. Inappropriately labeling such patients as "brain dead" will result in the failure to institute therapeutic hypothermia and other advanced neuroprotective interventions in patients who could be salvaged with a good neurologic outcome.
-
We studied if emergency department (ED) crowding affects the quality of resident and medical student education on individual patient encounters. ⋯ Emergency department crowding is not associated with the quality of education on individual patients.