The American journal of emergency medicine
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There is no pediatric overdose information available for perampanel. We present twocases involving children 2 years of age. ⋯ She was admitted to the pediatric intensive care unit and given fluids and was thendischarged after 20 hours. The other case involved a male who ingested 0.25mg/kgperampanel and developed ataxia within an hour, eventually he was discharged after 6hour observation in the emergency department without any treatment.
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Clinicians use the Modified Centor Score (MCS) to estimate the risk of group A streptococcal (GAS) pharyngitis in children with sore throat. The Infectious Diseases Society of America (IDSA) recommends neither testing nor treating patients with specific viral symptoms. The goal of this study is to measure the impact of those symptoms on the yield of GAS testing predicted by the MCS. ⋯ The presence of viral symptoms specified by the IDSA alters the predicted yield of testing by traditional MCS. Clinicians may consider adjusting interpretation of a patient's MCS based on the presence of viral symptoms, but viral symptoms may not always fully obviate the need for GAS testing.
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Spontaneous celiac artery dissection is a rare visceral artery dissection that typically presents with acute abdominal or flank pain. ⋯ We describe a case of a 54-year old previously healthy male who presented to the Emergency Department with subacute back pain and was found to have a spontaneous celiac artery dissection. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Emergency medicine physicians frequently consider acute aortic dissection in patients presenting to the Emergency Department with acute chest, back, and/or upper abdominal pain. Less commonly thought of are variations of arterial dissection, including those involving the celiac artery. Given readily available diagnostic imaging modalities and therapeutic interventions, it remains important to consider visceral arterial dissection, and to recognize the varied clinical manifestations of this rare clinical entity.
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Comparative Study
Presentation and outcomes of end stage liver disease patients presenting with septic shock to the emergency department.
Patients with end stage liver disease (ESLD) are particularly vulnerable to sepsis. ESLD patients are often excluded from controlled sepsis trials and more data are needed to guide the management of this population. ⋯ Patients with ESLD comprise a small but important subgroup of patients with ED septic shock that experience high mortality compared to patients without ESLD. Maximum ED lactate and pneumonia as the source of sepsis are independently associated with adverse outcome and may be used for early recognition of high-risk ESLD sepsis patients.