The American journal of emergency medicine
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A 33-year-old male presented to the emergency department with a chief complaint of abdominal pain after taking #50 500 mg acetaminophen tablets over the preceding two days. He was tachycardic and tachypneic, and the initial labs were notable for acetaminophen level, 337 mg/L; AST, 137 IU/L; ALT, 194 IU/L; ABG pH, 7.24; and lactate, 4.1 mmol/L. ⋯ Biochemical and animal data support fomepizole having hepatoprotective effects in acetaminophen poisoning. To our knowledge, this is the first human case of an intentional dual NAC/fomepizole regimen for severe acetaminophen toxicity.
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Injury of the spleen may result in significant morbidity and mortality, often related to blood loss. Splenic injuries may be missed on the initial Emergency Department (ED) presentation. This study was undertaken to describe cases of delayed diagnosis, and to identify factors associated with delayed diagnosis, treatment, and outcomes. ⋯ In this study, 6% of patients with splenic injury were not diagnosed during the initial ED encounter. These patients with delayed diagnosis had similar grade of injury, need for intervention, days of hospitalization, and outcome.
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Kounis syndrome is defined by the occurrence of an acute coronary syndrome (ACS) in the setting of an allergic, hypersensitivity or anaphylactic condition. Degranulation of mast cells and platelet activation leading to the release of multiple inflammatory mediators are thought to make the arterial circulation susceptible to acute cardiac events. It is an often underdiagnosed entity in the emergency setting, due to lack of awareness among emergency providers. ⋯ The patient's symptoms resolved and he had an uneventful hospitalization. The diagnosis of Kounis syndrome can complicate the management of acute allergic reactions. Special precautions should be taken by emergency physicians with regards to the administration of beta blockers, morphine and vasodilators, which may be detrimental in this setting.
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Case Reports
Acute perforated appendicitis after blunt abdominal trauma: A report from a 7-year-old boy and literature review.
Individually, trauma and appendicitis are some of the most common conditions in clinical practice, particularly in emergency medicine. In rare cases, trauma and appendicitis may co-exist, imposing a dilemma of whether these are only coincidence or appendicitis develops because of trauma. We report here a case of acute perforated appendicitis after a blunt abdominal trauma caused by a horse hoof kick to the abdomen in a 7-year-old boy. We also discussed the potential pathophysiologic mechanisms behind and reviewed the literature on this rare condition.
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Emergency departments are struggling to manage the increasing number of patients seen for opioid use disorders and opioid overdose. With opioid overdose deaths rising at alarming rates, emergency physicians are beginning to induce patients with long-acting opioids such as buprenorphine and referring patients to outpatient medication-assisted treatment facilities. The objective of this study was to describe a pragmatic approach to buprenorphine induction, referral to treatment, and assess follow-up rates. ⋯ Emergency department initiated buprenorphine induction using a structured pragmatic approach is effective at maintaining patients in medication-assisted therapy.