The American journal of emergency medicine
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Case Reports
Neurologic toxicity of carbamazepine in treatment of trigeminal neuralgia: A case report.
Carbamazepine is a medication used to treat a variety of neurological and psychiatric conditions including seizure disorders, neuropathic pain syndromes, and bipolar disorder. Unfortunately, its pharmacokinetics and side effect profile may lead to significant toxicities due to its sodium channel blockade. ⋯ In this article, we describe a case of a 40-year-old female who presented to a local emergency department with focal neurological deficits after repeated supratherapeutic dosing of carbamazepine.. This case highlights a key cerebrovascular accident mimic that emergency physicians should consider from acute toxicity that can be seen with carbamazepine in a patient who was taking the medication as prescribed.
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Meta Analysis
Effectiveness and safety of tranexamic acid in pediatric trauma: A systematic review and meta-analysis.
Trauma is the leading cause of childhood death in the United States. Our goal was to determine the effectiveness of tranexamic acid (TXA) in improving survival in pediatric trauma. ⋯ The utility of TXA in children with trauma is unclear. Guidelines supporting TXA use in pediatric trauma may not be based on the available evidence of its use in this context. Rigorous trials measuring survival and other meaningful outcomes and exploring optimal TXA dosing are urgently needed. Study Registration (PROSPERO): CRD42020157683.
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An increasing number of pediatric patients with inherited metabolic disorders are reaching adulthood. In addition, many patients are diagnosed for the first time in adult life due to improved awareness of these disorders and the availability of advanced diagnostic technology. Knowledge of these inherited metabolic disorders in adults is crucial for the emergency physician to promptly recognize their acute illness and appropriately manage them in the emergency department. ⋯ Acute metabolic decompensation is a life-threatening condition. The emergency physician is usually the first provider to evaluate these patients when they present to the emergency department. Early recognition of their illness and prompt management of these cases improve patient outcomes.
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Obstructive shock describes any disease process that causes physical obstruction to blood flow into or out of the heart which results in impaired systemic oxygen or nutrient delivery. Common etiologies include cardiac tamponade, tension pneumothorax, and pulmonary embolus. However, several other causes exist and should prompt consideration in the correct clinical circumstances. ⋯ Contrast enhanced computed tomography scans showed a massive hepatic cyst which was compressing her vena cava and heart, causing hemodynamic instability. The patient was admitted to the ICU and the hepatic cyst was drained percutaneously, but ultimately, she succumbed to her illness post-operatively. This report highlights the importance of keeping a broad differential when considering etiologies of undifferentiated shock as well as the need for additional research regarding management of rare causes of obstructive shock.