J Emerg Med
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The Centers for Disease Control reports that motor vehicle crashes (MVCs) are the leading cause of injury and death among U.S. teenagers, and disproportionately affect males. Among preventable causes of MVCs involving teenage drivers, distracted driving continues to be a serious public health problem. ⋯ Teenage male drivers perceive themselves to be safe drivers, but report engaging in more distracted driving and risky behaviors compared to females. These results suggest that there is an opportunity for gender-specific educational and injury prevention programs for teen drivers.
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Comparative Study Controlled Clinical Trial
Comparison of the Effects of Ketamine and Morphine on Performance of Representative Military Tasks.
When providing care under combat or hostile conditions, it may be necessary for a casualty to remain engaged in military tasks after being wounded. Prehospital care under other remote, austere conditions may be similar, whereby an individual may be forced to continue purposeful actions despite traumatic injury. Given the adverse side-effect profile of intramuscular (i.m.) morphine, alternative analgesics and routes of administration are of interest. Ketamine may be of value in this capacity. ⋯ Participants were more symptomatic with ketamine, yet the soldier skills were largely resistant to performance decrements, suggesting that a trained task skill (autonomous phase) remains somewhat resilient to the drugged state at this dosage. The performance decrements with ketamine may represent the subjects' adoption of a cautious posture, as suggested by risk propensity testing whereby the subject is aware of impairment, trading speed for preservation of task accuracy. These results will help to inform the casualty care community regarding appropriate use of ketamine as an alternative or opioid-sparing battlefield analgesic.
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Review Case Reports
Intravenous Lipid Emulsion in the Emergency Department: A Systematic Review of Recent Literature.
Intravenous lipid emulsion (ILE) has been broadly attempted in the resuscitation of neurologic and cardiac toxic drug overdoses, however, the role of ILE in the emergency department is poorly defined. ⋯ In the setting of severe hemodynamic compromise by lipid-soluble xenobiotics, ILE may be considered for resuscitation by emergency physicians. As such, ILE may be stocked in emergency departments in close proximity to resuscitation rooms and areas where local nerve blocks are performed.
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Review Case Reports
Persistent Effects after Camphor Ingestion: A Case Report and Literature Review.
Camphor is a well-known toxin responsible for thousands of poisonings per year. It can be found in many over-the-counter remedies and illegally imported substances. The toxidrome manifests within minutes and includes gastrointestinal, neurologic, pulmonary, and cardiac effects. Severe ingestions may progress to seizures, apnea, and coma. Most individuals are no longer symptomatic outside the 24-48 h window, but physiologic derangement may persist for far longer in some instances. ⋯ This is a case report of a 25-year-old Guatemalan woman with no past medical history who ingested a cube of camphor for a facial rash. She presented to the Emergency Department with persistent delirium and headache 6 days after ingestion. She had a protracted recovery but returned to her baseline state of health 19 days after ingestion. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Persistent toxic effects of camphor are not well described, and most sources state that the toxidrome resolves in 24-48 h. Given the frequency of camphor poisoning, it is crucial to increase public awareness of camphor toxicity, to understand the biological mechanism of the effects, and to develop more targeted treatments. From the emergency physician's perspective, it is important to realize that toxic effects of camphor poisoning may persist far beyond the 24-48 h window and require attention.
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Case Reports
Lateral Canthotomy and Cantholysis: Emergency Management of Orbital Compartment Syndrome.
Orbital compartment syndrome is a sight-threatening emergency. Vision may be preserved when timely intervention is performed. ⋯ Emergency physicians should be familiar with lateral canthotomy and cantholysis in the management of orbital compartment syndrome to minimize the chance of irreversible visual loss.