The American journal of emergency medicine
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Olanzapine (Zyprexa; Eli Lilly, Indianapolis, IN) is an antipsychotic medication that has been useful in the treatment of psychiatric disorders. In cases of overdose, cardiovascular and neurologic changes are seen. ⋯ Treatment with lipid emulsion resulted in amelioration of the symptoms. Inadvertent discontinuation of a lipid emulsion infusion led to recurrence of symptoms, which quickly resolved with an additional loading dose of lipid emulsion.
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Mild therapeutic hypothermia has been shown to improve outcomes after adult cardiac arrest but remains underused. Development of easier methods than currently exist to induce therapeutic hypothermia may help increase use of this treatment. We developed a mathematical model to evaluate the potential to induce mild therapeutic hypothermia through the esophagus. ⋯ Our computer simulations suggest that inducing mild therapeutic hypothermia via an esophageal route is feasible.
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Dislocations and subluxations at the metacarpal-phalangeal joint are rare and volar or palmar subluxations represent a small fraction of these. A 54-year-old man presented with an injury to his right hand; he had heard a pop while putting down a weight. He had normal vital signs, and his examination revealed a deformity at the third metacarpal-phalangeal joint. ⋯ Attempts at closed reduction in the emergency department were unsuccessful, and he was splinted with plans for follow-up. There are several characteristics of this injury that present a diagnostic challenge: most patients are able to make a fist due to intact flexor mechanism, the deformity is subtle and may be masked by swelling, and lateral radiographs tend not to image the joint well. Recognition of this injury and hand surgery consultation are essential because most described cases required open reduction.
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This study aims to determine the risk factors associated with the bacterial contamination of blood cultures among adults visiting the emergency department (ED). ⋯ Emergency department overcrowding may have an adverse impact on the quality of clinical care, including increasing the risk of blood culture contamination.
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Unintentional carbon monoxide poisoning is preventable. Severe cases are often referred for hyperbaric oxygen treatment. To guide prevention efforts and treatment practices, this study provides some of the most detailed current information about patients with carbon monoxide poisoning who have been treated at hyperbaric facilities across the United States and the circumstances surrounding their exposures. This study can help improve efforts to prevent carbon monoxide poisoning and enhance treatment practices. ⋯ The findings in this report expand the knowledge about patients with carbon monoxide poisoning. These results suggest that prevention efforts, such as educating the public about using carbon monoxide alarms and targeting the most at-risk populations, may help reduce the number of exposures, the number of persons with chronic cognitive sequelae, and the resulting burden on the health care system.