J Emerg Med
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Tick-borne relapsing fever (TBRF) is a zoonosis caused by spirochetes of the genus Borrelia. The zoonosis is endemic in higher-elevation coniferous forests of the western United States. ⋯ We discuss the case of a 44-year-old male residing in the San Juan Mountains of Western Colorado who presented with fever, myalgia, vomiting, and "violent chills" to an emergency department. Laboratory studies were notable for bandemia and thrombocytopenia with mild hyperbilirubinemia. Peripheral smear demonstrated multiple Borrelia spirochetes. The patient was treated with parenteral ceftriaxone and discharged with oral doxycycline therapy and recovered uneventfully. We discuss the clinical and epidemiological features of TBRF and the salient points for clinical diagnosis and management of this rare but important disease entity. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: TBRF is a rare and potentially life-threatening infectious process, which presents with nonspecific findings and often poses a diagnostic challenge. TBRF should be considered in the differential diagnosis for patients residing or vacationing in high-altitude forested areas in the western United States.
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Observational Study
Management and Outcomes of Bleeding Events in Patients in the Emergency Department Taking Warfarin or a Non-Vitamin K Antagonist Oral Anticoagulant.
Most comparisons of bleeding patients who are taking warfarin or a non-vitamin K oral anticoagulant (NOAC) have been limited to admitted patients and major bleeding events in well-controlled, clinical trial settings. ⋯ Despite the rare use of reversal strategies, mortality was low and outcomes were comparable among patients with bleeding events presenting to the ED while taking a NOAC compared with warfarin.
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Drug overdose is the leading cause of injury-related fatality in the United States, and respiratory failure remains a major source of morbidity and mortality. ⋯ Endotracheal intubation was infrequently performed on patients with acute drug overdose, and complications were rare when performed. Risk factors associated with endotracheal intubation included younger age and prior obstructive lung disease.