J Emerg Med
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Case Reports
Use of Intravenous Lipid Emulsion Therapy in a Case of Atomoxetine (Strattera®) Toxicity.
Clinical manifestations after overdose of atomoxetine are generally mild. However, it may have moderate or severe toxic effects such as drowsiness, agitation, hyperactivity, tremors, tachycardia, hyperreflexia, hypertension, and seizures. The duration of symptoms is usually short, lasting < 24 h. We report a case of atomoxetine toxicity, which can be considered of value, as intravenous lipid emulsion therapy has not been previously reported in an overdose of atomoxetine. This is a case of atomoxetine toxicity initially thought to be sertraline. ⋯ The case is presented of a 14-year-old girl with seizures following an overdose of atomoxetine who was unresponsive to intravenous benzodiazepine, but showed an improvement in overall condition after intravenous lipid emulsion therapy. To the best of our knowledge, there has been no previous report in the literature of the use of intravenous lipid therapy after atomoxetine overdose. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Intravenous lipid emulsion therapy is used as an alternative therapy in acute lipophilic drug intoxications. In children and adults, there is an increase in the use of intravenous lipid emulsion therapy in the life-threatening toxicity of many lipophilic drugs. Intravenous lipid emulsion therapy provides 'lipid sink' for toxic, lipophilic drugs, thereby effectively keeping toxic and lipophilic drugs out of the periphery. Intravenous lipid emulsion therapy reduces the distribution of lipophilic drugs.
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Emergency department thoracotomy (EDT) is done to control life threatening hemorrhage and injuries. Literature examining this topic is limited to relatively small studies from single trauma centers. ⋯ Factors associated with survival in patients undergoing EDT were identified. The clinical indication of presence of appropriate resources to continue and repair EDT was validated, along with the contraindications of lack of signs of life and presence of major nonsurvivable injuries. Future studies should focus on validation of all criteria of EDT, namely hemodynamic instability despite appropriate fluid resuscitation, duration of time of cardiopulmonary resuscitation and pulselessness, cardiac rhythm on arrival, and the presence of pericardial tamponade.
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Limited research exists examining the predictors of suicide attempts by mechanism. ⋯ Our findings inform targeted preventative resources and education efforts to populations of greatest need.