The American journal of emergency medicine
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Caffeine is the most commonly used central nervous system stimulant. While it has a high LD50 (150-200 mg/kg), when ingested in significant quantity, caffeine can lead to severe and even lethal side effects. Manifestation of toxicity include tachyarrhythmias, seizures, and metabolic derangements which can eventually lead to cardiovascular collapse and death. ⋯ Initial pre-dialysis caffeine level was found to be 254 μg/ml. After treatment with two sessions of hemodialysis the patient's caffeine level decreased dramatically. We believe this is the first case report to demonstrate the success of preemptive hemodialysis, prior to cardiovascular collapse and/or renal failure, in a case of caffeine overdose and should be considered very early in patients presenting with recent toxic ingestion.
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Review Meta Analysis
Ketamine for emergency sedation of agitated patients: A systematic review and meta-analysis.
Prior studies suggest that ketamine is effective for acute agitation in the emergency department (ED) and prehospital settings. This systematic review and meta-analysis aims to evaluate the rate of sedation and need for airway management in patients given ketamine for management of acute agitation. Methods: We performed a systematic review of publications describing the use of ketamine to control agitation in the ED and prehospital settings. ⋯ The estimate of the proportion of subjects that achieved sedation was 85% (95% CI = 0.71-0.93). After synthesizing data from the four studies that compared ketamine to controls, ketamine was associated with increased rates of sedation (RR, 1.95 [CI, 0.47-8.1]) and increased need for intubation (RR, 2.44 [CI, 0.75-7.91]). The differences were not significant by random effects model.
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Multicenter Study Comparative Study
Assessment of dextrose 50 bolus versus dextrose 10 infusion in the management of hyperkalemia in the emergency department.
Hypoglycemia is a common adverse effect when intravenous (IV) insulin is administered for hyperkalemia. A prolonged infusion of dextrose 10% (D10) may mitigate hypoglycemia compared to dextrose 50% (D50) bolus. Our objective was to evaluate whether D10 infusion is a safe and effective alternative to D50 bolus for hypoglycemia prevention in hyperkalemic patients receiving IV insulin. ⋯ In our study, D10 infusions appeared to be at least as effective as D50 bolus in preventing hypoglycemia in hyperkalemic patients receiving IV insulin. In context of ongoing D50 injection shortages, D10 infusions should be a therapeutic strategy in this patient population.
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Review Historical Article
Emergency medicine in China: A review of the history of progress and current and future challenges after 40 years of reform.
The year 2018 marks the 40th anniversary of China's reform, tremendous change had taken place in Chinese society. Looking back 40 years from 1978 to 2018, China's medical reform had made remarkable achievements, but still faces many challenges. These papers review the historical progress of emergency medicine, the current and the future challenges in China's medical reform process.
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The most recent guidelines on prescribing opioids from the United States Centers for Disease Control recommend that clinicians not prescribe opioids as first-line therapy for chronic non-cancer pain. If an opioid prescription is considered for a patient already on opioids, prescribers are encouraged to check the statewide prescription drug monitoring database (PDMP). Some additional guidelines recommend screening tools such as the Current Opioid Misuse Measure (COMM) which may also help identify drug-aberrant behaviors. ⋯ The PDMP alone is a more useful as a screening instrument than either the COMM or the combination of the PDMP plus COMM in patients already taking opioids at time of ED presentation. However, the PDMP misses a majority of patients with documented drug-aberrant behaviors in the EMR, and should not be used in isolation to justify whether a particular opioid prescription is appropriate.