J Emerg Med
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Pain management is critical to the management of patients in the emergency department (ED). The clinical decision-making process for prescribing medications is complicated by its subjective nature. Historically, racial and ethnic minority groups and women have not had their pain managed as aggressively as White and male patients. ⋯ Although differences in pain management practices have been explored previously, this study provided a large, updated, multifacility assessment that confirmed that race- and sex-based differences in pain management persist, specifically in the decision to treat with narcotics. Further investigation is warranted to determine the root causes of these differences.
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There are concerns that emergency health care workers are exposed to ionizing radiation as the result of frequent portable radiographs obtained in the emergency department (ED) during active patient care. ⋯ The level of radiation exposure to ED staff found in this study was well below the recommended allowable occupational exposure of 50 mSv/y. Radiation exposure is not a significant occupational hazard in a busy ED level I trauma center. Existing precautions should adequately protect staff from occupational exposure, and use of further protective gear, or the need for individual monitoring using dosimeters, appears unwarranted.
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Review Case Reports
Valproic Acid Overdose: Case Report and Literature Review.
Valproic acid (VPA) is a common antiepileptic drug that is also used routinely for various psychiatric disorders. VPA toxicity typically manifests as central nervous system depression, while hyperammonemic encephalopathy and hepatotoxicity are potentially life-threatening complications. ⋯ We describe the case of a 56-year-old man who presented to the emergency department after an intentional VPA overdose, was found to have hyperammonemia, and was treated with L-carnitine exclusively. He was subsequently admitted to the hospital for monitoring and serial laboratory testing. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Although VPA toxicity has conventionally been managed by gastric decontamination, L-carnitine, and, in severe and refractory cases, extracorporeal removal, recent literature supports the use of carbapenem antibiotics, particularly meropenem. Thus, we report the details of current treatment modalities for VPA toxicity by reviewing current literature.