The American journal of emergency medicine
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Patients with mental illness have been shown to receive lower quality of care and experience worse cardiovascular (CV) outcomes compared to those without mental illness. This present study examined mental health-related disparities in CV outcomes after an Emergency Department (ED) visit for chest pain. ⋯ Patients with mental illness have similar rates of MACE, but higher rates of certain CV outcomes, such as CV hospitalization and diagnostic testing, after an ED visit for chest pain.
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The introduction of scooter-share programs across the United States has led to an increased incidence of electronic scooter (e-scooter) injuries presenting to emergency departments (EDs). As legislation begins to push scooters from the sidewalk to the street, injuries resulting from collisions between e-scooters and motor vehicles are an important, but poorly characterized consideration. This study leverages data from a national injury surveillance system to characterize e-scooter versus motor vehicle collisions resulting in ED presentation. ⋯ Electric scooter injuries involving a motor vehicle differed from those that did not across several key categories. As e-scooters and motor vehicles start to share the road more frequently, greater consideration should be made regarding how these two modes of transportation interact with each other. The promotion of thoughtful e-scooter legislation and infrastructure changes could help promote safer travel.
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Observational Study
Risk of tizanidine-induced adverse events after concomitant exposure to ciprofloxacin: A cohort study in the U.S.
Tizanidine's potent muscle relaxant properties and short onset of action makes it desirable for pain management. However, concomitant use of tizanidine with ciprofloxacin, a strong inhibitor of the P450-CYP1A2 cytochrome metabolic pathway of tizanidine, can result in increased tizanidine plasma levels and associated adverse outcomes, particularly hypotension. The aim of this study was to assess the risk of hypotension with coadministration of tizanidine and ciprofloxacin. ⋯ Our findings suggest that the concomitant use of tizanidine and ciprofloxacin is associated with an elevated risk of hypotension. The prevalence of co-administration of drugs with a documented interaction highlights the need for continuous education across providers to avoid the incidence of DDI related adverse events and further complications and to improve patient outcomes.
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Cardiac tamponade is a rare but possibly fatal complication of blunt thoracic trauma complicated by a sternal fracture. A delayed presentation of cardiac tamponade days or weeks after initial trauma has been described in a few cases. ⋯ This case describes a direct mechanical perforation of the right ventricle, caused by a displaced sternal fracture, presenting 5 days after initial trauma. To our knowledge, this mechanism of late cardiac tamponade has not been described in recent literature.
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Case Reports
Treatment of status epilepticus and prolonged QT after massive intentional bupropion overdose with lidocaine.
Bupropion is an atypical antidepressant often used in the treatment of depression, tobacco cessation, seasonal affective disorder, and off label for ADHD. Its primary mechanism of action is by blocking dopamine and norepinephrine reuptake and it is structurally similar to amphetamines. Toxic effects include, most notably and classically, seizures as well as tachycardia, agitation, nausea and vomiting, QT prolongation, QRS widening, hypertension/hypotension. ⋯ Cardiotoxicity related to bupropion has previously been primarily supportive and avoidance of QT prolonging antiarrhythmics such as amiodarone, and at times requiring VA ECMO. Lidocaine has previously been used in tox cases to shorten QT intervals. The hope is for this information to be helpful to other EM and Critical Care providers when placed in similarly difficult circumstances.