The American journal of emergency medicine
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Review Meta Analysis
A year ReviewED: Top emergency medicine pharmacotherapy articles of 2021.
This article highlights the most relevant emergency medicine (EM) pharmacotherapy publications indexed in 2021. A modified Delphi approach was utilized for selected journals to identify the most impactful EM pharmacotherapy studies via the GRADE system. ⋯ Articles included in this review highlight acute agitation management, acute appendicitis treatment, sexually transmitted infection updates, optimizing sepsis management and treatment, updates for the ideal thrombolytic agent in acute ischemic stroke and endovascular therapy candidates, indications for tranexamic acid, calicium for out of hospital cardiac arrest, optimial inotrope for cardiogenic shock, awareness during rapid sequence intubation paralysis, comparison of propofol or dexmedetomidine for sedation, treatment of cannabis hyperemsis syndrome, and prophylactic use of diphenhydramine to reduce neuroleptic side effects. Selected articles are summarized to include design, results, limitations, conclusions and impact.
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Acute ataxia is commonly the chief complaint among patients visiting the emergency department (ED). It has multiple causes including infection and immunity-related, metabolic, vascular, and organic causes. Therefore, treating physicians should consider the severity and timing of onset in relation to the initial screening tests when making a differential diagnosis, and must be careful not to miss cases that require urgent treatment, such as stroke and drug-induced ataxia. ⋯ The plasma levels of phenytoin, carbamazepine, and valproic acid were 21.2 μg/mL (normal range: 7-20 μg/mL), 2.1 μg/mL (normal range: 5-10 μg/mL), and 33.5 μg/mL (normal range: 50-100 μg/mL), respectively. She was finally diagnosed with ataxia due to phenytoin toxicity. Her symptoms improved soon after the phenytoin dose was reduced and did not recur during a year of follow-up.