The American journal of emergency medicine
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Unintentional plant ingestions and poisoning are common. Generally, these ingestions are asymptomatic or minimally symptomatic. Increased toxicity is often associated with the foraging for plants incorrectly identified as edible plants. We present a case series of seven family members poisoned by suspected Death Camas, also known as Meadow Death Camas, (Toxicoscordion venenosum), when the plant was misidentified as edible while foraging for Wild Onion (Allium canadense). ⋯ Five children and two adults presented to the emergency department after eating bulbs of suspected Death Camas (Toxicoscordion venenosum). Symptoms began within 30 to 60 min including nausea, vomiting, and abdominal pain. This was followed by bradycardia and hypotension consistent with Death Camas poisoning from alpha blockade, sodium channel activation, and increased vagal activity from the toxins. All of the patients required admission to the intensive care unit. Six patients were treated with supportive care alone and two patients required vasopressor support. An 89-year-old female developed a wide complex tachycardia and was treated with amiodarone. All patients had resolution of toxicity within 24 h and were discharged to home. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Foodborne illness is a common presentation highlighted by signs and symptoms manifesting in multiple people eating the same meal. The misidentification of toxic plants as edible is associated with acute onset of signs and symptoms of toxicity. The toxins associated with Death Camas (Toxicoscordion venenosum), commonly thought to be edible Wild Onion (Allium canadense), are unique as these can cause gastrointestinal effects (e.g., nausea, vomiting, diarrhea), and cardiovascular effects (e.g., bradycardia, hypotension), which are often refractory to supportive therapy alone (e.g., crystalloid fluids), and can require atropine and vasopressors.
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The global increase in neonatal visits to Pediatric Emergency Departments (PEDs) underscores the need to better understand the factors driving these visits and their implications. The often vague and nonspecific symptoms of neonates pose significant challenges for clinicians and caregivers in determining the appropriate level of care, impacting the frequency of return visits and overall effectiveness of discharge education. ⋯ This study identified specific complaints that were most likely to result in hospital admissions and return visits to the ED. This can guide targeted educational interventions for caregivers and ED providers and refinement of triage protocols to ensure that neonates receive the most appropriate and efficient care.
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Post-cardiac arrest care advancements have improved resuscitation outcomes, but many survivors still face severe neurological deficits or death from brain injury. Herein, we propose a consistent prognosis prediction approach using magnetic resonance imaging (MRI) to analyze anatomical regions represented by the gray and white matter, and subsequently apply it on computed tomography (CT) to calculate the gray-white matter ratio (GWR). We compared this novel method with traditional measures to validate its ability to predict the prognosis of patients resuscitated after cardiac arrest. ⋯ Our study introduces a novel method for measuring GWR using MRI-based brain CT, demonstrating superior prognostic accuracy in predicting neurological outcomes in patients with post-cardiac arrest syndrome compared to traditional methods.
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Central retinal artery occlusion (CRAO) is an ophthalmic emergency characterized by sudden loss of vision with a low chance of spontaneous recovery. This case report presents a 49-year-old female with sudden right eye visual loss, diagnosed as non-arteritic CRAO. Fundoscopic examination revealed retinal pallor, and optical coherence tomography demonstrated edema of the inner retinal layer, consistent with CRAO. ⋯ It also emphasizes the importance of considering cardiac comorbidities, particularly PFO, in younger CRAO patients, and underscores the need for a multidisciplinary approach and comprehensive stroke-etiology workups in CRAO management. This report contributes to the limited evidence on CRAO treatment in Japan, particularly in the context of lower tPA dosing and associated cardiac abnormalities. It underscores the importance of early diagnosis, treatment, and thorough etiological investigation in improving outcomes for CRAO patients.