The American journal of emergency medicine
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Unintentional plant ingestions and poisoning are common. Generally, these ingestions are asymptomatic or minimally symptomatic. Increased toxicity is often associated with the foraging for plants incorrectly identified as edible plants. We present a case series of seven family members poisoned by suspected Death Camas, also known as Meadow Death Camas, (Toxicoscordion venenosum), when the plant was misidentified as edible while foraging for Wild Onion (Allium canadense). ⋯ Five children and two adults presented to the emergency department after eating bulbs of suspected Death Camas (Toxicoscordion venenosum). Symptoms began within 30 to 60 min including nausea, vomiting, and abdominal pain. This was followed by bradycardia and hypotension consistent with Death Camas poisoning from alpha blockade, sodium channel activation, and increased vagal activity from the toxins. All of the patients required admission to the intensive care unit. Six patients were treated with supportive care alone and two patients required vasopressor support. An 89-year-old female developed a wide complex tachycardia and was treated with amiodarone. All patients had resolution of toxicity within 24 h and were discharged to home. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Foodborne illness is a common presentation highlighted by signs and symptoms manifesting in multiple people eating the same meal. The misidentification of toxic plants as edible is associated with acute onset of signs and symptoms of toxicity. The toxins associated with Death Camas (Toxicoscordion venenosum), commonly thought to be edible Wild Onion (Allium canadense), are unique as these can cause gastrointestinal effects (e.g., nausea, vomiting, diarrhea), and cardiovascular effects (e.g., bradycardia, hypotension), which are often refractory to supportive therapy alone (e.g., crystalloid fluids), and can require atropine and vasopressors.
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To measure the association between patient race and physical restraint use in the ED. ⋯ Black patients were more likely to be physically restrained compared to White patients, though the magnitude of this association was small compared to that of other clinical risk factors. Future work should evaluate if these findings are driven by differences in patient characteristics or clinician decision-making to best inform interventions to reduce this disparity.
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The global increase in neonatal visits to Pediatric Emergency Departments (PEDs) underscores the need to better understand the factors driving these visits and their implications. The often vague and nonspecific symptoms of neonates pose significant challenges for clinicians and caregivers in determining the appropriate level of care, impacting the frequency of return visits and overall effectiveness of discharge education. ⋯ This study identified specific complaints that were most likely to result in hospital admissions and return visits to the ED. This can guide targeted educational interventions for caregivers and ED providers and refinement of triage protocols to ensure that neonates receive the most appropriate and efficient care.
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When the initial rhythm of cardiac arrest is non-shockable, resuscitation outcomes tend to be unfavorable. However, signs of life (gasping, pupillary light reaction, or any form of body movement) have been suggested as favorable prognostic factors for patients with refractory cardiac arrest who are undergoing extracorporeal cardiopulmonary resuscitation (ECPR). This study determined whether signs of life are favorable neurological prognostic factors for patients undergoing ECPR post non-shockable cardiac arrest. ⋯ Signs of life during resuscitation were favorable prognostic factors in patients with refractory cardiac arrest and non-shockable rhythm. When these patients are considered for ECPR, the status of signs of life during resuscitation may facilitate the decision to perform ECPR.
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Iron products are widely available over the counter and have the potential to cause serious toxicity. Iron concentrations can be used to prognosticate and guide treatment during acute ingestions. Traditionally, a concentration of 350 μg/dL with symptoms, or 500 μg/dL without symptoms, is considered toxic and will likely need treatment to prevent decompensation. It is generally recommended that an iron concentration is obtained at least 4 h after exposure to provide adequate absorption time and avoid falsely low iron concentrations. Despite this, many iron overdoses have concentrations drawn immediately upon patient presentation. The utility of an iron concentration drawn before 4 h in assessing exposure risk is not clear. The purpose of this study is to determine if patients' symptoms and iron concentrations obtained between 2 and 4 h can predict the development of iron concentrations after 4 h. ⋯ Patients with only minor GI symptoms and an iron concentration of ≤ 300 μg/dL between 2 and 4 h post-ingestion are unlikely to develop further toxicity. In this case series, a concentration of 300 μg/dL or less between 2 and 4 h was the ideal cutoff to predicting subsequent potentially toxic concentrations, with a sensitivity of 100 % and a specificity of 54 %.