The American journal of emergency medicine
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Observational Study
Clinical effects of intravenous bupropion misuse reported to a regional poison center.
Bupropion is an antidepressant medication with expanding indications including smoking cessation, weight loss, attention-deficit/hyperactivity disorder, seasonal affective disorder, and amphetamine dependence. Despite its increasing popularity among providers, it has a well-known narrow therapeutic window which can lead to delayed onset of symptoms with extended-release formulations and devastating consequences in overdose. We have noticed some patients misusing bupropion via intravenous use and had difficulty guiding decisions regarding clinical monitoring in these patients. ⋯ No deaths were reported. All patients were symptomatic by the time of initial call to the poison center if they had any reported symptoms due to bupropion. This case series describes the clinical effects reported, and the timing of these effects, after intravenous bupropion use.
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Concussions and chronic traumatic encephalopathy (CTE) related to professional football has received much attention within emergency care and sports medicine. Research suggests that some of this may be due to a greater likelihood of initial helmet contact (IHC), however this association has not been studied across all age groups. This study aims to investigate the association between player age and IHC in American football. ⋯ There is a high rate of IHC with a lower relative risk of IHC at most levels of play compared to the NFL. Further research is necessary to determine the impact of IHC; the high rates across all age groups suggests an important role for education and prevention.
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Patients with small intracranial hemorrhage at initial presentation (ICHi) have a relatively uneventful hospital course, as compared with larger ICHi. In this study, we tested the null hypothesis that ICHi does not impact the symptom profile of patients with traumatic brain injury (TBI) after discharge. ⋯ ICHi does not impact the symptom profile of patients with TBI in either short or long term.
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Cardiac hemangiomas are exceedingly rare and can lead to cardiac tamponade. Cardiac tamponade is a true medical emergency that can cause cardiovascular collapse and death if not managed appropriately. ⋯ For patients with cardiac tumors causing tamponade, emergent pericardiocentesis and cardiovascular surgery consultation are necessary in management. We present a unique case of cardiac tamponade caused by a cardiac hemangioma.
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Case Reports
An unusual case of spontaneous nontraumatic pneumocephalus in the setting of remote craniofacial surgery.
Pneumocephalus is an uncommon pathology that typically follows head trauma, neurosurgery, or skull base tumors. Rarely, cases of spontaneous pneumocephalus can occur, most often in the setting of barotrauma. ⋯ Although rare, spontaneous pneumocephalus should be considered even in the absence of clinical neurologic findings or barotrauma, in patients with previous cranial surgery and unexplained headaches.