The American journal of emergency medicine
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Case Reports
Management of a severe carbamazepine overdose with continuous venovenous hemodiafiltration.
Carbamazepine (CBZ) is a commonly used antiepileptic agent. Common toxic effects include neurological abnormalities; ataxia, seizures, coma, cardiorespiratory problems; dysrhythmias; conduction disorders; respiratory depression; and eye abnormalities, such as nystagmus and ophthalmoplegia. Carbamazepine is highly protein bound. ⋯ Supportive measures and charcoal hemoperfusion have been regarded as efficient treatment methods. We herein report a 17-year old girl to whom continuous venovenous hemodiafiltration lacking the albumin-enhance after suicidal overdose of CBZ was performed. We suggest continuous venovenous hemodiafiltration lacking the albumin-enhance as an alternative emergency treatment modality for cases who had ingested CBZ in toxic levels.
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Therapeutic hypothermia has been reported to improve the neurologic outcome of comatose survivors of out-of-hospital cardiac arrest. The use of therapeutic hypothermia in patients who have had an acute ischemic-hypoxic brain injury after a suicidal intoxication has not been previously reported. We present the case of a young woman who presented comatose to our emergency department after attempting suicide by ingesting diazepam and a bottle of antifreeze (ethylene-glycol). ⋯ The patient awoke within 48 hours of rewarming and made a complete and full neurologic recovery. In conclusion, this case has important implications in the management of patients who have had an acute ischemichypoxic brain injury. Inappropriately labeling such patients as "brain dead" will result in the failure to institute therapeutic hypothermia and other advanced neuroprotective interventions in patients who could be salvaged with a good neurologic outcome.
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We studied if emergency department (ED) crowding affects the quality of resident and medical student education on individual patient encounters. ⋯ Emergency department crowding is not associated with the quality of education on individual patients.
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Early goal-directed therapy (EGDT) has become regarded as the standard of care for the management of patients with severe sepsis and septic shock. The elements of EGDT have been bundled together as the "Sepsis Bundle," and compliance with the elements of the bundle is frequently used as an indicator of the quality of care delivered. The major elements of EGDT include fluid resuscitation to achieve a central venous pressure of 8 to 12 cm of water, followed by the transfusion of packed red cells or an inotropic agent to maintain the central venous oxygen saturation higher than 70%. Although the concept of early resuscitation is a scientifically sound concept, we believe that the major elements of the sepsis bundle are fatally flawed.