Annals of emergency medicine
-
The increased prevalence of rodents resistant to warfarin led to the development of the hydroxycoumarin anticoagulant brodifacoum. A 25-year-old man attempted suicide by consuming four boxes of d-CON Mouse-Prufe II; each box contains 42 g of bait that is 0.005% brodifacoum. He presented to a hospital nine days later with syncope, hematochezia, gross hematuria, epistaxis, anemia, and a severe coagulopathy. ⋯ Neurologic status was initially normal, but in the emergency department he suddenly became comatose soon after emesis was induced with syrup of ipecac. Computed tomography of the brain revealed a subarachnoid hemorrhage that led to brain death less than 24 hours later. This case demonstrates the severe and prolonged coagulopathy that can result from ingestion of brodifacoum, a compound that has a toxic potency about 200-fold that of warfarin and a half-life as much as 60 times longer.
-
Randomized Controlled Trial Clinical Trial
Optimal patient position for transport and initial management of toxic ingestions.
Many factors influence the rate of gastric emptying and therefore the rate of drug absorption in the orally poisoned patient. Limited studies have evaluated the effect of body position on the rate of gastric emptying of radiographically marked foods and contrast media, but effects on drug absorption have not been studied previously. Our hypothesis was that body position would have an effect on the rate of drug absorption in an oral overdose model. ⋯ Initial drug absorption as determined by two-hour AUC was lowest in the left lateral decubitus position. Although the difference between the left lateral decubitus and supine positions did not reach statistical significance, both left lateral decubitus and supine were significantly lower than three other common patient body positions tested. Because the left lateral decubitus position has other advantages (eg, prevention of aspiration) in addition to minimizing drug absorption, we recommend that orally poisoned patients be placed in the left lateral decubitus position for prehospital and initial ED management.
-
Physicians and the public often assume that herbal preparations are harmless. Aconite is a Chinese herb used as an analgesic by homeopaths; its chief effects are on the cardiovascular and central nervous systems. The first two reported cases of aconite poisoning in Australia are described.
-
Randomized Controlled Trial Multicenter Study Comparative Study Clinical Trial
Histamine antagonists in the treatment of acute allergic reactions.
We compared the efficacies of cimetidine (an H2-receptor antagonist) and diphenhydramine (an H1-receptor antagonist) alone and in combination for alleviation of symptoms of acute allergic reactions. STUDY DESIGN AND INTERVENTIONS: In this prospective, randomized, double-blind study, patients and examiners assessed the severity of symptoms and signs of acute allergic reactions using a visual-analog scale before treatment and 30 minutes after treatment with 300 mg IV cimetidine and placebo, 50 mg IV diphenhydramine and placebo, or diphenhydramine plus cimetidine. ⋯ For treatment of pruritus from acute allergic reactions, diphenhydramine is more effective than cimetidine, and the combination offers no additional benefit. For treatment of acute urticaria, the combination of cimetidine and diphenhydramine is more effective than diphenhydramine alone.
-
Emergency medicine faculty have 24-hour clinical responsibilities in addition to the academic requirements of research and administration/teaching. This study was undertaken to determine the existing and ideal work style of such faculty by professional rank, administrative title, and/or tenure versus clinical track. ⋯ Emergency medicine faculty accomplish the clinical, research, and teaching/administrative demands of academia by increasing the number of faculty, varying the faculty responsibilities by rank and title, and shortening the total work week. Research time is extremely limited.