The American journal of emergency medicine
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Fentanyl is a high potency opioid that has become an increasingly large proportion of the illicit drug supply. Fentanyl overdoses and deaths, including in pediatric patients, has concomitantly increased. ⋯ Providers should be aware of these illicit tablets, know not to assume they are pharmaceutical, and consider the risk they pose to pediatric patients through exploratory ingestion or misuse. Further inquiry, including social investigation, should be considered for pediatric patients presenting with reported oxycodone ingestion, especially blue "M30" pills.
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In order to determine if time from onset to treatment time (OTT) to alteplase (tPA) administration is associated with improved outcomes in acute ischemic stroke, we performed a retrospective analysis of all acute ischemic stroke patients who received tPA at our hospital. ⋯ Our small, retrospective data shows no association between OTT and either hemorrhagic conversion or mRS at 90 days. This data lends support that time may not be the ideal indicator for identifying patients who will benefit from tPA administration.
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Case Reports
Success in early treatment with lipid emulsion for antihypertension drug overdose patient.
Intravenous lipid emulsion (ILE) is typically applied as a rescue therapy after the use of conventional treatments for beta blocker (BBs) or calcium channel blocker (CCB) overdoses. We describe the case of a 72-year-old man who presented to our ED after attempting suicide by antihypertensive drug overdose. His blood pressure dropped upon arrival at the ED, and we consequently administered multitherapy including relatively early ILE to prevent prolonged hypotension. He regained stable hemodynamic status on the third day and was later discharged without major sequelae.
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Targeted temperature management is a class I indication in comatose patients after a cardiac arrest. While the literature has primarily focused on innovative methods to achieve target temperatures, pharmacologic therapy has received little attention. We sought to examine whether pharmacologic therapy using antipyretics is effective in maintaining normothermia in post cardiac arrest patients. ⋯ Among patients undergoing targeted temperature management, relying solely on as needed use of antipyretics is not sufficient to maintain temperatures <38 °C. However, antipyretics could be used as an initial strategy if given regularly and/or in conjunction with more aggressive cooling techniques.
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Pediatric patients comprise 13% of emergency medical services (EMS) transports, and most are transported to general emergency departments (ED). EMS transport destination policies may guide when to transport patients to a children's hospital, especially for medical complaints. Factors that influence EMS providers 'decisions about where to transport children are unknown. Our objective was to evaluate the factors associated with pediatric EMS transports to children's hospitals for medical complaints. ⋯ We found that younger patient age, EMS protocol requirements, and paramedic scene response may influence pediatric patient transport to both children's and community hospitals. Socioeconomic factors, ED proximity, diversion status, respiratory rate, chief complaints, and communication barriers may also be contributing factors. Further studies are needed to determine the generalizability of these findings to other EMS systems.