J Emerg Med
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Caffeine (1,3,7-trimethylxanthine) is a naturally occurring compound found in plants and is the most utilized drug in the world. An estimated 89% of U.S. citizens and 80% of people worldwide consume caffeine on a regular basis. The prevalence of caffeine supplementation by individuals has been increasing in body-weight regulation (e.g., weight loss, body building). When used in excessive amounts it can precipitate serious health consequences, including death. Given this, and the ease of accessibility, caffeine has been seen in intentional overdose. However, suicide attempts via caffeine overdose are rare. In 2017, the American Association of Poison Control Centers reported 3765 cases of caffeine overdose, of which 650 were intentional and none resulted in death from caffeine alone. An ingestion of 5 g (80-100 mg/kg) is likely to prove fatal. ⋯ We present the case of a suicide attempt via caffeine with a reported 20-g overdose, which would be an estimated blood caffeine level of 427.1 mg/L. The patient was given activated charcoal and treated for symptomatic tachycardia and diaphoresis. He was ultimately evaluated by Psychiatry and was discharged home with no adverse outcomes from his intentional overdose. We also examine the physiology of the potential adverse effects of caffeine use and the current literature related to caffeine overdoses. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Caffeine is consumed by billions of individuals globally. It is rarely associated with death, but can cause a variety of adverse effects including tachydysrhythmias, hypokalemia, seizures, and rhabdomyolysis. Caffeine overdoses should be treated immediately with activated charcoal if within the appropriate timeframe of 1-2 h post-ingestion, and special attention should be given to the cardiovascular effects of caffeine, as tachydysrhythmias may prove fatal.
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Review Case Reports
Multisystem Inflammatory Syndrome in Children (MIS-C) in an Adolescent that Developed Coronary Aneurysms: A Case Report and Review of the Literature.
A small subset of pediatric patients develop a rare syndrome associated with Coronavirus Disease 2019 (COVID-19) infection called multisystem inflammatory syndrome in children (MIS-C). This syndrome shares characteristics with Kawasaki disease. ⋯ A 15-year-old girl presented to our Emergency Department (ED) with fevers and malaise. She was diagnosed on her initial visit with an acute viral syndrome and discharged with a COVID polymerase chain reaction test pending, which was subsequently negative. She returned 3 days later with persistent fever, conjunctivitis, and a symmetric targetoid rash over her palms. She had no adenopathy, but her erythrocyte sedimentation rate and C-reactive protein were both significantly elevated at 90 mm/h and 19.61 mg/dL, respectively. The patient was then transferred to the regional children's hospital due to a clinical suspicion for MIS-C, and subsequent COVID-19 immunoglobulin G testing was positive. She had been empirically started on intravenous immunoglobulin in addition to 81 mg aspirin daily. Initial echocardiograms showed mild dilatation of the left main coronary artery, and on repeat echocardiogram, a right coronary artery aneurysm was also identified. Oral prednisone therapy (5 mg) was initiated and the patient was discharged on a continued prednisone taper. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: We present a case of a 15-year-old girl who presented to the ED with MIS-C who developed coronary aneurysms despite early therapy, to increase awareness among emergency physicians of this emerging condition.
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Multicenter Study Comparative Study
Volume and Acuity of Emergency Department Visits Prior To and After COVID-19.
There are scant data regarding the change in volume and acuity of patients presenting to emergency departments (EDs) after Coronavirus Disease 2019 (COVID-19), compared with the pre-COVID-19 era. ⋯ Sharp declines in ED visits and the triage acuity seen in both general and specialty hospitals raise the concern that severely ill patients may not be seeking timely care, and a surge may be expected once current restrictions on movement are lifted.
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Randomized Controlled Trial
Time to Loss of Preoxygenation in Emergency Department Patients.
In patients requiring emergency rapid sequence intubation (RSI), 100% oxygen is often delivered for preoxygenation to replace alveolar nitrogen with oxygen. Sometimes, however, preoxygenation devices are prematurely removed from the patient prior to the onset of apnea, which can lead to rapid loss of preoxygenation. ⋯ In this population of non-critically ill ED patients, most had loss of preoxygenation after 5 breaths if all oxygen devices were removed, and after 8 breaths if a nasal cannula was left in place. These data suggest that during ED RSI, preoxygenation devices should be left in place until the patient is completely apneic.