J Emerg Med
-
Bupropion is not known to have direct serotonin agonism or inhibit serotonin reuptake. In spite of this, it has been implicated as a causative agent of serotonin syndrome. We highlight two cases of single-agent bupropion overdose that subsequently met the diagnosis of serotonin syndrome by the Hunter criteria, despite the absence of direct serotonergic agents. ⋯ This may be due to an indirect increase in activity of serotonergic cells. In these cases, bupropion overdose resulted in a clinical presentation consistent with serotonin syndrome, with the first having a temporal improvement after treatment with cyproheptadine. Physicians need to be aware of the potential serotonergic activity of bupropion for accurate assessment and treatment of this dangerous condition.
-
A meconium aspirator is a simple plastic adapter that allows for rapid suctioning of the trachea when attached to an endotracheal tube and a source of continuous negative pressure, as was historically done for suspected neonatal meconium aspiration. Adaptation of this technique for the emergent vacuum extraction of an obstructing tracheal foreign body in an adult has not been previously described. ⋯ We report the case of a 33-year-old woman with cardiorespiratory arrest after choking on food. Complete tracheal obstruction precluding oxygenation and ventilation due to aspirated chicken was diagnosed by emergency physicians and managed immediately with vacuum extraction using the technique described in this report. No additional airway interventions were necessary and the patient made a full neurologic recovery. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Vacuum extraction using a meconium aspirator and modified endotracheal tube is a novel and potentially life-saving approach to the emergency management of airway obstruction after choking, especially if the foreign material is below the vocal cords and not amenable to manual extraction with a Magill forceps.
-
Appendicitis is a common pediatric surgical emergency, and the diagnosis may be delayed or missed because of nonspecific findings in children. Not all patients with abdominal pain need to be imaged for appendicitis, and laboratory evaluation may improve diagnostic accuracy in this population. ⋯ No laboratory test studied has adequate characteristics to be used alone. CRP adds minimal sensitivity beyond WBC and ANC when symptoms are >1 day but with poor specificity, making it of limited utility.
-
Case Reports
Vaping-Associated Lung Injury During COVID-19 Multisystem Inflammatory Syndrome Outbreak.
E-cigarette or vaping product use-associated lung injury (EVALI) is a complex inflammatory syndrome predominantly seen in adolescents and young adults. The clinical and laboratory profile can easily mimic infectious and noninfectious conditions. The exclusion of these conditions is essential to establish the diagnosis. Recently, the novel coronavirus disease 2019 (COVID-19) pandemic introduced the multisystem inflammatory syndrome in children (MIS-C). MIS-C knowledge is evolving. The current criteria to establish the diagnosis are not specific and have overlapping features with EVALI, making the accurate diagnosis a clinical challenge during continued COVID-19 transmission within the community. ⋯ Three young adults evaluated at our emergency department for prolonged fever and gastrointestinal and respiratory symptoms were initially assessed for possible MIS-C due to epidemiologic links to COVID-19 and were eventually diagnosed with EVALI. The clinical, laboratory, and radiologic characteristics of both entities are explored, as well as the appropriate medical management. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Physician awareness of overlapping and differentiating EVALI and MIS-C features is essential to direct appropriate diagnostic evaluation and medical management of adolescents and young adults presenting with systemic inflammatory response during the unfolding pandemic of COVID-19.