Apr 27th, 15

Chemical Change In Synthetic Marijuana Suspected Of Causing Illnesses

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Apr 6th, 15

Californians increasingly visiting hospital ERs for non-injury care

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Californians are increasingly likely to visit a hospital emergency room for complex medical problems rather than an injury, according to new research.

Although hospital emergency departments, or EDs, were once known as “accident rooms,” a review of all non-federal hospital emergency rooms in California from 2005 to 2011 found that injury-related visits have declined over that time period, according to a study published Monday in the journal Health Affairs.

Overall, emergency room visits due to injury fell nearly 1% while visits brought on by complex medical issues such as gastrointestinal disease and mental illness rose by more than 13%, the researchers found.

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Apr 5th, 15

Family Poisoned By Methyl Bromide at Luxury Resort

A U.S. family vacationing in St. John was apparently poisoned by methyl bromide, a highly toxic pesticide the use of which has been severely limited in the U.S. Exposure to methyl bromide can result in nausea, abdominal pain, weakness, confusion, pulmonary edema, and seizures. Neurologic effects can be long-lasting and even permanent.

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Apr 4th, 15

Lessons from the battlefield are transforming emergency medicine in huge ways

Lessons from the battlefield are transforming emergency medicine in huge ways
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About 35 million people are treated in the United States each year for traumatic injuries, such as those cause by gunshots and car accidents. Trauma is the leading cause of death for Americans under 44, according to the Trauma Center Association of America.

The techniques brought home since the Sept. 11, 2001, attacks on the United States are a reflection of the historic low in combat deaths in Iraq and Afghanistan.

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Apr 4th, 15

Arsenic, Toxicology, and the Problem of Science in the Courtroom

Arsenic, Toxicology, and the Problem of Science in the Courtroom
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Contemporary debates about expert witnesses and scientific evidence in courtrooms are nothing new. 150 years ago people—scientists, lawyers, jurists, and journalists—raised questions about when to rely on expert witnesses, how much weight should be given to their testimony, and how to evaluate the results of their scientific tests alongside other forms of evidence.

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Jul 1st, 12

Childhood Poisonings from New Detergent Packets on the Rise

A new blog post in the New York Times highlights the danger (particularly to children) of new laundry detergent packets. Due to their small size and bright colors, many toddlers and small children have been eating them, leading to significant symptoms including severe nausea and vomiting, respiratory distress, and metabolic abnormalities. Some children have also suffered eye damage which can occur when children bite into the packets, spraying caustic material into their eyes.

Poison control centers across the country have been seeing an average to 10 cases a day over recent months, and sometimes as many as 28 a day; more than 1200 cases have been reported to poison control centers this year.

This report should serve as a stark reminder to parents that these products, like all household products, should be kept in a locked cabinet in an area well out of the reach of children.

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Jun 23rd, 12

ACEP Issues Clinical Policy on Opioid Prescribing for Patients Presenting to the Emergency Department

Deaths due to prescription opioids are a significant problem, accounting for nearly 15,000 fatalities in 2008 (a more than threefold increase compared to 10 years previously). In fact, deaths due to drug overdoses are second only to motor vehicle crashes as a cause of injury-related deaths. The American College of Emergency Physicians (ACEP) has recognized that this is an issue of significant public health concern and has issued a new policy addressing issues with prescribing opioids to patients presenting to the emergency department (ED). Among the highlights:

The use of a state prescription monitoring program may help identify patients who are at high risk for prescription opioid diversion or doctor shopping.
Emergency physicians should determine whether nonopioid analgesics (i.e., acetaminophen or NSAIDs) may be adequate for initial pain management.
Given the risks associated with opioid use, misuse, and abuse, opioids should be reserved for more severe pain or pain refractory to other analgesics rather than routinely prescribed.
If opioids are indicated, the prescription should be for the lowest practical dose for a limited duration (e.g., <1 week), and the prescriber should consider the patient’s risk for opioid misuse, abuse, or diversion.
Physicians should avoid routinely prescribing outpatient opioids for a patient with an acute exacerbation of chronic noncancer pain seen in the ED.
ED physicians should attempt to honor existing patient-physician pain contracts/treatment agreements and consider past prescription patterns from information sources such as prescription drug monitoring programs.

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Jun 18th, 12

Hydroxocobalamin Superior to Sodium Thiosulfate for Treating Severe Cyanide Toxicity

Dr. Tanen’s new article on treatment of acute cyanide toxicity has just been published in Annals of Emergency Medicine. Dr. Tanen and his co-authors induced severe cyanide toxicity a swine model and then administered one of three treatments: hydroxocobalamin (the active ingredient in Cyanokit), sodium thiosulfate (one of the primary components classically used for treatment of cyanide toxicity), or hydroxocobalamin + sodium thiosulfate. There was 100% mortality in the sodium thiosulfate group versus 8% mortality in the hydroxocobalamin group and 17% in the hydroxocobalamin + sodium thiosulfate group.

This adds to the growing body of literature suggesting that hydroxocobalamin should replace the original cyanide antidote kit as the standard treatment for severe cyanide toxicity.

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Jun 15th, 12

Researchers Identify Risk Factors for Death from MRSA Bacteremia

A new study by Dr. Mina Pastagia et al. has identified risk factors for death from bacteremia due to MRSA. In a retrospective study of 699 cases of MRSA bacteremia in 603 patients, researchers noted that advanced age, residence in a nursing home, severe bacteremia, and organ impairment were independently associated with increased risk of death. Consultation with an infectious disease specialist was associated with a significantly decreased risk of mortality.

Overall mortality was 31.5%. More than 40% of the patients had had surgery within the previous 3 months, and in 43% of cases a central venous catheter was found to be the source of infection.

According to the lead author, “The consequences of MRSA bacteremia are clear — many patients will die or experience a decline from their baseline clinical condition. The adjusted risk difference enables clinicians to use a targeted approach, directed toward patients with the highest risk of death… These patients should be treated carefully and should possibly receive a consult from an infectious diseases specialist. What remains unclear is whether patients at increased risk for death should be treated with antimicrobial drugs other than vancomycin.”

These findings can help clinicians to estimate the risk that a patient with MRSA bacteremia will die and to determine the need for infectious disease consultation, thereby potentially improving the chances that the patient will survive.

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