GCS of 8… But Should You Intubate?
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In patients with suspected acute poisoning who are comatose, a more restrictive intubation approach where intubation is withheld unless an accompanying emergent indication is present, may lead to fewer ICU admissions, decreased ICU length of stay, and decreased requirement for mechanical ventilation, with fewer adverse events.
Source
Effect of Noninvasive Airway Management of Comatose Patients With Acute Poisoning: A Randomized Clinical Trial. JAMA. 2023 Dec 19;330(23):2267-2274. doi: 10.1001/jama.2023.24391.
Should Testing for THC in Altered Children Be Routine?
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Given a substantial increase in the number of children who have accidental ingestion of THC-based products, these authors advocate for consideration of early urine drug screen testing on children who present with altered mental status or neurological symptoms.
Source
Urine Toxicology Test for Children With Altered Mental Status. Pediatrics. 2023. Nov 1;152(5):e2022060861Doi: 10.1542/peds.
Loperamide (Imodium) and Mitragynine (Kratom) and Risk of Ventricular Arrhythmia
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Loperamide, an over-the-counter antidiarrheal opiate, and mitragynine (kratom) are both associated with ventricular arrhythmia and death.
Source
Ventricular Arrhythmias Associated With Over-the-Counter and Recreational Opioids. J Am Coll Cardiol. 2023 Jun 13;81(23):2258-2268. doi: 10.1016/j.jacc.2023.04.009.
AHA Guideline | 10 Tips Life-Threatening Toxicity From Poisoning
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Here are ten tips from the AHA for the next super-sick poisoned patient you encounter.
Can We Use Rivastigmine for the Treatment of Antimuscarinic Delirium?
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In this small, retrospective review of 22 patients with antimuscarinic delirium who received antidotal therapy with transdermal +/- oral rivastigmine, there were no major adverse effects observed, and symptom resolution generally occurred within a matter of hours.
Source
Greene SC. Rivastigmine Use in the Treatment of Antimuscarinic Delirium. J Med Toxicol. 2023 Jul;19(3):284-287. doi: 10.1007/s13181-023-00947-1. Epub 2023 May 19.
Alcoholic Hepatitis – Spoon-Feed Version
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Patients with alcohol-associated hepatitis have a high rate of complications and short-term mortality of 20-50%. Prompt recognition and treatment, including initiation of treatment for alcohol use disorder, is important to improve patient outcomes.
Source
Alcohol-Associated Hepatitis. NEJM. 2022 Dec 29; 387 (26): 2436-2448.
Inebriation Estimation – Can You Guess Blood Alcohol Levels?
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ED clinicians are often inaccurate in their estimations of patients’ blood alcohol content (BAC). Overestimation is common, especially in patients arriving by ambulance compared to walk-ins.
Source
Clinician assessment of blood alcohol levels among emergency department patients. Am J Emerg Med. 2023 Jan;63:110-112. doi: 10.1016/j.ajem.2022.10.045. Epub 2022 Oct 31.
Xylazine (aka Tranq) – What You Need to Know
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Xylazine is a non-opioid emerging drug of abuse that can cause significant respiratory and CNS depression in overdose as well as necrotic skin ulcerations. It does not respond to naloxone.
Source
Warning About Xylazine, a Veterinary Sedative Found in Illicit Drugs. JAMA. 2022 Dec 20;328(23):2296. doi: 10.1001/jama.2022.20045.
AMS, Hyperthermia, Hyperreflexia? How to Nail This Clinical Diagnosis
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Here are the clinical clues to keep you from missing serotonin syndrome (SS) and pearls to treat it once you make the diagnosis.
Is It Just Me or Are We Seeing More Cannabis Hyperemesis?
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Legalization of cannabis in Ontario was not associated with an increase in ED visits for cannabis hyperemesis syndrome (CHS); however, after legislation passed allowing commercialization of cannabis, there was a large increase in visits for CHS.
Source
Changes in Emergency Department Visits for Cannabis Hyperemesis Syndrome Following Recreational Cannabis Legalization and Subsequent Commercialization in Ontario, Canada. JAMA Netw Open. 2022 Sep 16. Doi:10.1001/jamanetworkopen.2022.31937