J Emerg Med
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Case Reports
New-Onset Seizure in Patient Medicated With Bupropion for Smoking Cessation: A Case Report.
Bupropion is a pharmacologic agent approved by the U.S. Food and Drug Administration as an antidepressant and to support smoking cessation. Because reduction of seizure threshold is a rare but serious side effect of bupropion, its use in patients with a known history of seizures is contraindicated. We report a patient without seizure risk factors who presented to the emergency department (ED) with new-onset seizures secondary to bupropion use. ⋯ A 66-year-old female presented to the ED by emergency medical services with altered mental status. She was determined to be postictal after a witnessed new-onset seizure 4 days after starting bupropion for smoking cessation. She had no personal or family history of seizure disorders, although her medication list raised suspicion that recent discontinuation of alprazolam may have contributed to a reduced seizure threshold. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: New-onset seizures secondary to bupropion use are less likely in patients with no personal or family history of seizure disorders. Emergency medicine clinicians should be aware, however, of the seizure risk associated with bupropion regardless of personal risk factors. Discontinuation of bupropion should be considered if determined to be a contributor to seizures.
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Comparative Study
Quality Comparison of the Manual Chest Compression and the Mechanical Chest Compression During Difficult Transport Conditions.
Although there are several studies comparing the quality of manual and mechanical chest compressions, we decided to conduct this study because results of previous studies were not sufficient for us to arrive at a definite conclusion. ⋯ In our study, while carrying the patient simulator manikin to the lower floor, it was found that the MCCD achieved high-quality CPR targets recommended by resuscitation guidelines in terms of compression rate, depth, and hands-on-time.
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Case Reports
A Helpful Tool in Diagnosing Stroke Mimics: Arterial Spin Labeled Perfusion Magnetic Resonance Imaging.
Prompt and effective management of acute ischemic stroke in the emergency setting requires a high level of suspicion and accurate diagnosis. Conversely, identifying stroke mimics can be challenging, given the similarity of their clinical symptomatology, the necessary rapid assessment and triage, and the overall frenetic pace inherent in the goal of rapid thrombolysis ("time is brain"). ⋯ We describe a case that involves an elderly patient with acute hemiplegia and dysarthria. Given these concerning symptoms, and multiple preexisting cerebrovascular risk factors (including paroxysmal atrial fibrillation), a "stroke alert" was issued. Imaging was negative for infarct and she was ultimately diagnosed with hemiplegic migraine based on her symptoms and impressive findings on a novel magnetic resonance sequence called arterial spin labeled (ASL) perfusion. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Identifying a nonischemic etiology in a presumed stroke patient, while often difficult, can obviate unnecessary treatment, improve patient care, and promote appropriate resource allocation. As imaging and treatment of cerebrovascular disease advances, the optimization of multidisciplinary care should incorporate neuroradiologists informing and availing their clinical colleagues of applications of an ever-expanding imaging armamentarium. This case is an excellent example of both a common challenging stroke mimic and the potential benefits of ASL perfusion imaging in refining and expediting accurate diagnosis. In addition, it serves as a more general introduction to the particular strengths of this noninvasive, noncontrast magnetic resonance technique, which can be employed to assess varied emergent neuropathology.