J Emerg Med
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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.
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Hidradenitis suppurativa (HS) is a chronic immune-mediated inflammatory skin disease characterized by abscesses and inflammatory nodules, and occasionally tunnels and scars, in the axillae, groin, and inframammary areas. ⋯ Practice variations between how care for HS is provided in the ED setting and what HS treatment guidelines recommend are identified.
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Numerous studies have reported existing disparities in academic medicine. The purpose of this study was to assess racial and gender disparity in academic emergency medicine (EM) faculty positions across the United States from 2007 to 2018. ⋯ Despite an increase in proportional representation, the underrepresentation of female faculty members and those from minority groups persists in emergency medicine. Further studies are needed to identify and address the root causes of these differences.
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Observational Study
Improvement of Procedure Documentation Compliance With the Implementation of a Visual Aid.
Emergency department (ED) providers face increasing task burdens and requirements related to documentation and paperwork. To decrease the mental task burden for providers, our institution developed an infographic that illustrates which forms are necessary for complete documentation of nonemergent invasive procedures. ⋯ Implementing an invasive procedure documentation infographic and direct feedback improved overall documentation compliance for nonemergent invasive procedures.
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Women have higher mortality from acute coronary syndrome (ACS) compared with men. Women may hesitate to search for emergency care when experiencing chest pain, which delays treatment. ⋯ In this population-level study of Curitiba, Brazil, the reduction in ED visits during the COVID-19 pandemic was greater in women than in men, particularly among those > 70 years of age, suggesting that the sex- and age-related disparities in health care delivery for ACS may have worsened during the COVID-19 pandemic.