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This descriptive study discussed a protocol to treat a fentanyl and xylazine subtype of opiate use withdrawal using one of four pathways. Use of the pathway resulted in lower against medical advice dispositions and Clinical Opiate Withdrawal Scale (COWS) scores.

Source 
Tranq Dope: Characterization of an ED cohort treated with a novel opioid withdrawal protocol in the era of fentanyl/xylazine.Am J Emerg Med. 2024 Sep 4;85:130-139. doi: 10.1016/j.ajem.2024.08.036. Epub ahead of print. Erratum in: Am J Emerg Med. 2024 Oct 8:S0735-6757(24)00523-0. doi: 10.1016/j.ajem.2024.10.006. PMID: 39260041.

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In contrast to yesterday's paper, this retrospective study of more than 8,000 out-of-hospital cardiac arrest (OHCA) patients detected higher rates of ROSC and survival discharge among patients who received naloxone.

Source
Naloxone and Patient Outcomes in Out-of-Hospital Cardiac Arrests in California. JAMA Netw Open. 2024 Aug 1;7(8):e2429154. doi: 10.1001/jamanetworkopen.2024.29154. PMID: 39163042; PMCID: PMC11337064.

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This analysis of more than 700 out-of-hospital cardiac arrest (OHCA) patients in an area with a high prevalence of opioid overdose did not find an association between naloxone administration and improved patient outcomes.

Source
Outcomes of Out-of-Hospital Cardiac Arrest Patients Who Received Naloxone in an Emergency Medical Services System With a High Prevalence Of Opioid Overdose. J Emerg Med. 2024 Sep;67(3):e249-e258. doi: 10.1016/j.jemermed.2024.03.038. Epub 2024 Apr 9. PMID: 39034160.

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Maintaining a high suspicion for botulism is crucial in making a prompt diagnosis and in reducing morbidity and mortality. This review highlights pearls and pitfalls of diagnosis and management.

Source
High risk and low prevalence diseases: Botulism. Am J Emerg Med. 2024 Aug;82:174-182. doi: 10.1016/j.ajem.2024.06.018. Epub 2024 Jun 20. PMID: 38925095.

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There are an increasing number of water bead related injuries in children, with the majority occurring in children less than five. While most cases can be treated and released from the ED, water bead injury can be serious and even deadly.

Source
Pediatric water bead-related visits to United States emergency departments. Am J Emerg Med. 2024 Jul 28:84:81-86. doi: 10.1016/j.ajem.2024.07.048. Online ahead of print. PMID: 39096713

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This pig cadaver study argues that jam is a reasonable alternative (if honey and sucralfate are unavailable) to give patients while awaiting definitive endoscopic removal after button battery ingestion.

Source
Home Therapies to Neutralize Button Battery Injury in a Porcine Esophageal Model. Ann Emerg Med. 2024 Apr;83(4):351-359. doi: 10.1016/j.annemergmed.2023.08.018. Epub 2023 Sep 19. PMID: 37725021.

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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.

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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.

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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.

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Here are ten tips from the AHA for the next super-sick poisoned patient you encounter.