J Emerg Med
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In the province of Quebec (Canada), paramedics use the esophageal tracheal Combitube (ETC) for prehospital airway management. ⋯ Proportions of successful ventilation and ETC first-pass success are lower than those reported in the literature with supraglottic airway devices. The reasons explaining these lower rates and their impact on patient-centered outcomes need to be studied.
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Hydroxychloroquine overdose is rare but potentially lethal. Hydroxychloroquine overdose symptoms are characterized by central nervous system toxicity, cardiac toxicity, and hypokalemia. Recommended treatment consists of epinephrine, high-dose diazepam, and careful potassium repletion. Few pediatric hydroxychloroquine overdoses have been reported. ⋯ We describe a 14-year-old girl who ingested 10 g (172 mg/kg) of hydroxychloroquine. She developed tachycardia, hypotension, and hypokalemia. She was intubated and treated with diazepam and epinephrine infusions and potassium supplementation. Her serum hydroxychloroquine concentration obtained 10 h after ingestion was 13,000 ng/mL (reference range 500-2000 ng/mL). The patient made a full medical recovery. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Pediatric hydroxychloroquine overdoses are reported rarely, and the toxic and lethal doses of hydroxychloroquine ingestion have not been established. This case of a teenaged patient who ingested 10 g of hydroxychloroquine and survived provides additional information that may be used to help establish toxic and lethal doses of ingestion.
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Otilonium bromide is a quaternary ammonium compound commonly used in the management of irritable bowel syndrome. There are no previously published cases of overdose of otilonium bromide in humans. Due to its poor systemic absorption, it acts locally and has an excellent safety profile. Data from safety and postmarketing observation showed that otilonium bromide is well tolerated and that side effects do not differ significantly from those seen with placebo. The drug has proven to be practically toxicity free in animals and hence, assumed not to cause any specific problems in humans in case of overdose. ⋯ We report a rare case of a 16-year-old girl who developed systemic hypotension (76/40 mm Hg) after an overdose of otilonium bromide tablets. She ingested 25 tablets of otilonium bromide (40 mg) over a period of 4 h. Subsequently, she responded to a bolus of normal saline and calcium gluconate, leading to normalization of her hemodynamic parameters. Why Should an Emergency Physician Be Aware of This? Due to a lack of reported cases, it is generally assumed that otilonium bromide overdose does not cause any specific problems in humans. However, with the drug being widely used for irritable bowel syndrome and other conditions, the chance of encountering cases of otilonium bromide overdose will increase. Through this case we aim to increase awareness among emergency physicians regarding the potential toxic effects of otilonium bromide overdosage.
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The differentiation of myocardial infarction (MI) in the setting of acute heart failure (AHF) can be challenging because the majority of patients presenting with AHF show elevations of high-sensitive troponin (hs-Tn). Fast identification of MI is crucial to perform timely coronary angiography and to improve clinical outcome. ⋯ Hs-TnT-based identification of type 1 MI in patients with AHF requires higher cut-offs compared with the 99th percentile URL used in overall acute coronary syndrome populations. However, the adjusted cut-off provided only moderate sensitivity and specificity.
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Head injuries are an important cause of morbidity and mortality in children and young adults. There are multiple sight-threatening complications of head injury, even in closed head injury without visible violation of the globe or orbits. One such entity is traumatic optic neuropathy. ⋯ Herein we describe a case of traumatic optic neuropathy in an otherwise healthy teenage patient who suffered total monocular vision loss after a fall and without any other injuries on examination. Unfortunately, the prognosis for this condition is relatively poor in terms of visual recovery. Though much research has been conducted attempting to treat this condition, to date there have been no studies showing a clear benefit of medical or surgical intervention. Why Should an Emergency Physician Be Aware of This? Although there is no proven treatment for traumatic optic neuropathy, emergency physicians may encounter this in their practice while caring for both pediatric and adult patients presenting with head injury. Having more background knowledge on this condition will enhance emergency physicians' ability to consult with subspecialist providers as well as to educate patients and their families on their condition and prognosis.