J Emerg Med
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Perampanel is a new antiepileptic used to treat partial-onset seizures and generalized tonic-clonic seizures in people older than 12 years old. Perampanel is a selective, non-competitive α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid (AMPA) receptor antagonist, with a prolonged half-life of approximately 105 hours. Few cases of significant toxicity have been reported, and effects in overdose are poorly understood. ⋯ This case describes a 20-month-old healthy female who ingested 8 mg of perampanel. She presented to a pediatric emergency department 1 hour after ingestion with ataxia, irritability, and somnolence. Vital signs were: heart rate 130 beats per minute, blood pressure 112/97 mmHg, temperature 99°F, respiratory rate 30 breaths per minute. She was admitted to the pediatric intensive care unit. During the hospitalization, she developed hypotension and bradycardia which improved with stimulation and fluid resuscitation. Intermittent bradycardia persisted for 32 hours after ingestion. Physical examination was notable for somnolence and truncal ataxia with irritability when aroused, all of which improved throughout the hospitalization. A quantitative level obtained on hospital day 3 (HD) was 750ng/ml. On HD 3 the patient was noted to be ataxic but otherwise had an age-appropriate neurologic examination. She was discharged on HD 4 with normal vital signs, return to baseline mental status, and baseline gait. The patient's cardiovascular, neurologic, and behavioral symptoms were attributed to perampanel toxicity. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS ?: Toxicity from a perampanel overdose is poorly understood both in adults and pediatric patients with significant cardiovascular, behavioral, and central nervous system abnormalities.
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Burns are a common condition presenting to the emergency department; the majority are thermal burns. The treatment for thermal burns and chemical burns differs greatly, and prompt recognition of a chemical burn is necessary. An often unrecognized and underestimated type of chemical burn is an alkali burn from wet cement. ⋯ A 7-year-old boy was transferred from an outside facility for evaluation of burns after exposure to wet cement. The patient underwent partial decontamination at the outside facility with polyethylene glycol and, to prevent ongoing alkali burns, the patient necessitated further decontamination with irrigation. Burn surgery was consulted for additional evaluation. The patient required no further intervention and the patient was discharged to home and made a full recovery. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Serious morbidity and mortality can occur from unrecognized cement burns, and early decontamination and evaluation by a burn surgeon is necessary. It is critical that emergency physicians both recognize and appropriately treat this condition in a timely manner to prevent adverse outcomes.
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Residency is expected to be a long and difficult road. When living in Lebanon, however, this path can be even more demanding. ⋯ In this essay, I narrate how I experienced the past two years in Lebanon from protests, to an economic collapse, to a massive urban explosion and a pandemic. This narrative is a reflection on the challenges experienced as both an Emergency Medicine resident and a Lebanese citizen working in these settings.