J Emerg Med
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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.
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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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Early initiation of a new P2Y12 inhibitor in ST-elevation myocardial infarction (STEMI) patients prior to primary percutaneous coronary intervention (PCI) is recommended over clopidogrel. However, comparative data remain limited, especially in semi-rural regions with subsequent longer transfer times. ⋯ Compared with clopidogrel, pretreatment with new P2Y12 inhibitors seems to be associated with lower risks of mortality and ischemic outcomes, and similar risks of bleeding in a real-world registry. Our results are in line with the guidelines recommending the preferential pre-PCI administration of new P2Y12 inhibitors in STEMI patients referred for primary PCI.
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Priapism can be categorized as low flow or high flow. Low flow priapism is a compartment syndrome and requires immediate treatment to avoid long-term ischemic damage. Alternatively, high flow priapism is not an emergent condition and can be managed as an outpatient. The diagnosis has traditionally been made via cavernosal blood gas analysis; however, this is painful and can cause iatrogenic harm. ⋯ We present a case of high flow priapism whereby point-of-care ultrasound (POCUS) identified the presence of pulsatile cavernosal arterial flow to confirm the diagnosis. This is the first case report in the emergency medicine literature to highlight the utility of POCUS in the diagnosis and management of high flow priapism. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Low flow priapism accounts for 95% of cases and is a urologic emergency requiring immediate invasive intervention. High flow priapism is much less common and does not require emergent management. While blood gas analysis can differentiate between high and low flow priapism, POCUS is a rapid, noninvasive, accurate diagnostic means to identify the presence or absence of cavernosal pulsatile arterial flow.