The American journal of emergency medicine
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Case Reports
Severe caffeine poisoning successfully treated with high flow continuous hemodialysis: A case report.
In recent years, severe or lethal cases of caffeine poisoning after large or massive ingestion of caffeinated tablets have increased in Japan. Here we report the case of a 23-year-old male who ingested high-dose caffeine tablets (total: 32.4 g caffeine) in a suicide attempt. He was transferred to our hospital about 2 h after ingesting the tablets and presented with repeated vomiting and tremor in the trunk and extremities. ⋯ This dramatically improved his clinical signs and symptoms, especially during the first 3 h. His serum caffeine concentration was 240.9 μg/mL on admission and 344.0 μg/mL at the initiation of high flow CHD, but rapidly decreased to 153.8 μg/mL 3 h after initiating high flow CHD. Our findings suggest that high flow CHD may be effective in treating cases of severe caffeine poisoning with hemodynamics too unstable for intermittent hemodialysis.
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A 41-year-old otherwise healthy women presented to the emergency department via emergency services after collapsing after feeling a "slap" on her head while celebrating a national holiday. Physical exam and computed tomography scan showed the presence of a retained ballistic fragment in her high parietal scalp, making her the victim of injury by celebratory gunfire, an illegal, but not uncommon, practice. She was admitted for concussive symptoms, her bullet was removed without incident and after a period of observation she was discharged in stable condition to home.
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Inhaled epoprostenol is a selective pulmonary vasodilator that has shown a potentially broad number of applications in the management of critically ill patients. To date, the vast majority of the literature with regard to efficacy, indications for use, and adverse effects of inhaled epoprostenol is focused on use of this agent in critical care settings, with relatively little literature describing use of inhaled epoprostenol in the Emergency Department. This retrospective review sought to examine instances in which inhaled epoprostenol was administered in the Emergency Department of a tertiary-care, Level I trauma center following implementation of a clinical pathway for administration of this medication for cases of refractory hypoxemia, RV dysfunction, and refractory hypoxemia. Primary outcomes were monitoring for adverse effects (i.e. hypotension), trend in FiO2 requirement over time, and clinical indication for initiation of inhaled epoprostenol. ⋯ In this review of cases in which inhaled epoprostenol was administered following adoption of a clinical pathway for medication administration, there were no cases of hypotension or other adverse effects that appear to be attributable to medication administration. Pulmonary embolism and refractory hypoxemia were the most common noted indications for administration of inhaled epoprostenol. Further research is warranted regarding development of clinical protocols for administration of inhaled pulmonary vasodilators in the Emergency Department setting.
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There is insufficient research on digestive symptoms and outcomes following coronavirus disease (COVID-19) vaccination. We aimed to investigate digestive symptoms and related complications among South Koreans who were administered COVID-19 vaccines. ⋯ COVID-19 vaccines caused digestive symptoms and other complications that ranged from mild to severe. While further validation is required, our results suggest that monitoring digestive symptoms following COVID-19 vaccination can help detect rather severe complications that require medical intervention.
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Observational Study
Association between patient age and pediatric cardiac arrest recognition by emergency medical dispatchers.
Dispatcher-assisted cardiopulmonary resuscitation (DA-CPR) is an important prognostic factor in pediatric out-of-hospital cardiac arrest (OHCA). The recognition of cardiac arrest by dispatcher is a key factor for successful DA-CPR. In this study, we evaluated the association between pediatric age and dispatcher recognition. ⋯ Patients ages 7-18 years old were negatively associated with cardiac arrest recognition and DA-CPR instruction provision within optimal timeframes compared to those younger than one year old. Development of a tailored protocol could be considered according to age and cause of arrest for better dispatcher performance in pediatric OHCA patients.