J Emerg Med
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Vilazodone is a selective serotonin reuptake inhibitor and 5HT1A agonist recently approved to treat depression in adults. To date, there are minimal data available regarding the expected course and treatment of acute vilazodone ingestions. ⋯ We report a case of a previously healthy 19-month-old girl who presented after an acute ingestion of an estimated 37 mg/kg vilazodone. She was taken to an outside emergency department approximately 1 h after an unwitnessed ingestion. Initially, the patient was noted to have decreased responsiveness, sluggish but reactive pupils, altered mental status, and reported seizure activity. She was given intravenous lorazepam for seizure control, intubated, and transferred to a pediatric tertiary care facility, where she continued to show signs of serotonin toxicity and received treatment with benzodiazepines and cyproheptadine. Despite vilazodone's long half-life and the large amount ingested, the patient was extubated within 10 h of presentation, had returned to baseline mental status by 22 h, and was discharged home approximately 57 h after ingestion. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Accidental ingestions are common in the pediatric population. Emergency physicians need to be aware of the signs and symptoms of acute medication toxicities, the expected clinical course, and the necessary supportive measures used to treat these patients. Because vilazodone is a recently approved medication, there is little experience with acute vilazodone ingestions. This report considerably increases the understanding of vilazodone's effects in the setting of an acute ingestion.
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Pericardial tamponade is a life-threatening condition that can occur, albeit rarely, in patients with ovarian cancer. Whether or not prolonged survival is possible after such an event is debatable. Our aim was to describe our experience with seven ovarian cancer patients who experienced malignant cardiac tamponade at tumor diagnosis or at recurrence. ⋯ Six patients were treated with pericardiocentesis and one with pericardial fenestration. Survival after tamponade ranged from 3 to 72 weeks. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: We suggest that when pericardial effusion occurs in patients with recurrent ovarian cancer, timely diagnosis and proper management might allow palliation and prolongation of life.
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Weakness is a common presentation in the emergency department (ED). Asymmetric weakness or weakness that appears not to follow an anatomical pattern is a less common occurrence. Acute flaccid paralysis with no signs of meningoencephalitis is one of the more uncommon presentations of West Nile virus (WNV). Patient may complain of an acute onset of severe weakness, or even paralysis, in one or multiple limbs with no sensory deficits. This weakness is caused by injury to the anterior horn cells of the spinal cord. We present a case of acute asymmetric flaccid paralysis with preserved sensory responses that was eventually diagnosed as neuroinvasive WNV infection. ⋯ A 31-year-old male with no medical history presented with complaints of left lower and right upper extremity weakness. Computed tomography scan was negative and multiple other studies were performed in the ED. Eventually, he was admitted to the hospital and was found to have decreased motor amplitudes, severely reduced motor neuron recruitment, and denervation on electrodiagnostic study. Cerebrospinal fluid specimen tested positive for WNV immunoglobulin (Ig) G and IgM antibodies. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Acute asymmetric flaccid paralysis with no signs of viremia or meningoencephalitis is an unusual presentation of WNV infection. WNV should be included in the differential for patients with asymmetric weakness, especially in the summer months in areas with large mosquito populations.
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A well-functioning primary care system has the capacity to provide effective care for patients to avoid nonurgent emergency department (ED) use and related costs. ⋯ These findings highlight the improvement in ambulatory care quality as the potential target area to effectively reduce nonurgent ED care costs.
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Several high-profile violent incidents have occurred within emergency departments (EDs). There are no recent studies reporting the effectiveness of ED metal detection. ⋯ A large number of weapons were retrieved after the initiation of metal detection in the ED entrance. Increasing hours of metal detection increased the number of retrieved knives, chemical sprays, and other weapons. Retrieved firearms decreased after increasing metal detection hours. Metal detection in the ED entrance is effective in reducing entrance of weapons into the ED. Metal detectors may offer additional benefit in reducing attempts to enter with firearms.