The American journal of emergency medicine
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Case Reports
Severe caffeine poisoning treated with intermittent hemodialysis under circulatory support: A case report.
Caffeine poisoning can cause fatal ventricular arrhythmias. In this report, we describe a case of severe caffeine poisoning with extraordinarily high blood caffeine levels. Despite developing refractory ventricular fibrillation, the patient was successfully treated with intermittent hemodialysis (IHD) under circulatory support by venoarterial extracorporeal membrane oxygenation (VA-ECMO). ⋯ Renal replacement therapy (RRT) including intermittent hemodiafiltration, continuous hemodiafiltration, and IHD was continued because of rhabdomyolysis with myoglobinuria and secondary caused acute kidney injury. The patient was weaned off VA-ECMO on hospital day 7, extubated on hospital day 18, weaned from RRT on hospital day 46, and was transferred to another hospital for physical rehabilitation on hospital day 113. IHD under circulatory support by VA-ECMO should be considered in severe caffeine poisoning causing potentially fatal arrhythmias.
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Observational Study
End-tidal carbon dioxide after sodium bicarbonate infusion during mechanical ventilation or ongoing cardiopulmonary resuscitation.
End-tidal CO2 is used to monitor the ventilation status or hemodynamic efficacy during mechanical ventilation or cardiopulmonary resuscitation (CPR), and it may be affected by various factors including sodium bicarbonate administration. This study investigated changes in end-tidal CO2 after sodium bicarbonate administration. ⋯ The administration of sodium bicarbonate may lead to a substantial increase in end-tidal CO2 for several minutes in patients with spontaneous circulation and in patients with ongoing CPR. After intravenous administration of sodium bicarbonate, the use of end-tidal CO2 pressure as a physiological indicator may be limited.
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The "allergy epidemic" of the Western World, has led to an overwhelming number of emergency department presentations with allergic rhinitis, allergic conjunctivitis, atopic eczema, and asthma. Careful consideration should be given to screening for the typical signs and symptoms of Mixed connective tissue disease (MCTD) in patients presenting to the ED with what appears to be a simple allergic process. MCTD is a rare systemic rheumatic disease characterized by high levels of anti-U1RNP antibodies and various clinical signs and symptoms. ⋯ The patient was evaluated by the Allergy and Rheumatology services. The patient was ultimately diagnosed with MCTD-Myositis Overlap Syndrome and started on steroids and IVIG with improvement in symptoms. While MCTD is not a diagnosis readily made in the ED, early identification and treatment of the disease is critical for prevention of long term complications.
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As artificial intelligence (AI) expands its presence in healthcare, particularly within emergency medicine (EM), there is growing urgency to explore the ethical and practical considerations surrounding its adoption. AI holds the potential to revolutionize how emergency physicians (EPs) make clinical decisions, but AI's complexity often surpasses EPs' capacity to provide patients with informed consent regarding its use. This article underscores the crucial need to address the ethical pitfalls of AI in EM. ⋯ The central question arises: Are EPs equipped with the necessary knowledge to offer well-informed consent regarding clinical AI? Collaborative efforts between EPs, bioethicists, AI researchers, and healthcare administrators are essential for the development and implementation of optimal AI practices in EM. To facilitate informed consent about AI, EPs should understand at least seven key areas: (1) how AI systems operate; (2) whether AI systems are understandable and trustworthy; (3) the limitations of and errors AI systems make; (4) how disagreements between the EP and AI are resolved; (5) whether the patient's personally identifiable information (PII) and the AI computer systems will be secure; (6) if the AI system functions reliably (has been validated); and (7) if the AI program exhibits bias. This article addresses each of these critical issues, aiming to empower EPs with the knowledge required to navigate the intersection of AI and informed consent in EM.