The American journal of emergency medicine
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Letter Case Reports
Amphetamine toxicity masked by concomitant γ-hydroxybutyrate (GHB) ingestion.
We report a case of a young male with amphetamine toxicity initially obscured by concomitant use of gamma-hydroxybutyrate (GHB), and the sympathomimetic symptoms emerged after GHB's effects receded. A 24-year-old unconscious man presented to emergency department showed the following vital signs upon admission: blood pressure 136/58 mmHg; heart rate 79 bpm; SpO2 87% under ambient air; body temperature 36.1 °C; Glasgow Coma Scale score 3. The pupils were not dilated. ⋯ The patient improved later and was extubated at 4 days after the mitigation of pneumonia and discharged uneventfully 8 days later. In our patient, amphetamine intoxication was initially masked by concomitant use of GHB but appeared as GHB's effect attenuated. We wish to remind clinicians of variable clinical presentations of polydrug abuse.
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As physicians attempt to "Choose Wisely" and decrease ionizing radiation, the use of Magnetic Resonance Imaging (MRI) has increased. While MRI does not expose patients to ionizing radiation, it does expose patients to specific risks, such as thermal burns. Unfortunately, obese patients are at the highest risk for MRI-related thermal burns. ⋯ The burn required debridement twice at the nearest burn center and healed slowly thereafter. Emergency physicians should be aware of the risks of MRI so they can counsel patients prior to diagnostic MRI and adequately evaluate patients with complaints after MRI. Furthermore, patients with MRI-related burns may rarely present with delayed, occult deep-tissue involvement requiring burn center evaluation and treatment.