Intentional overdose of the novel anti-epileptic drug eslicarbazepine presenting with recurrent seizures and ventricular dysrhythmias

CJEM ◽  
2017 ◽  
Vol 20 (S2) ◽  
pp. S44-S47 ◽  
Author(s):  
Jesse Thompson ◽  
James D. Powell ◽  
Daniel H. Ovakim
Keyword(s):  
Emergency Department ◽  
Cardiac Toxicity ◽  
The Novel ◽  
Successful Management ◽  
Intentional Ingestion ◽  
Wide Complex Tachycardia ◽  
Anti Epileptic Drug ◽  
Refractory Seizures ◽  
Neurologically Normal ◽  
Ventricular Dysrhythmias

AbstractEslicarbazepine is a novel anti-epileptic agent indicated for the treatment of partial-onset seizures. We present the case of an 18 year old female that presented to the Emergency Department four hours after a reported intentional ingestion of an estimated 5600 mg of eslicarbazepine. Although initially hemodynamically stable and neurologically normal, shortly after arrival she developed confusion, rigidity and clonus, followed by recurrent seizures, hypoxemia and cardiac arrest which responded to cardiopulmonary resuscitation and wide complex tachycardia requiring defibrillation. Treatment for refractory seizures included benzodiazepines and eventual intubation and sedation with propofol. Cardiac toxicity responded to sodium bicarbonate. In addition, empiric hemodialysis was performed. In this case report, we discuss the successful management of the first reported overdose of eslicarbazepine using supportive care and hemodialysis.

scholarly journals Colpocephaly Diagnosed in a Neurologically Normal Adult in the Emergency Department

2019 ◽  
Vol 3 (4) ◽  
pp. 421-424
Author(s):  
Christopher Parker ◽  
Wesley Eilbert ◽  
Timothy Meehan ◽  
Christopher Colbert
Keyword(s):  
Emergency Department ◽  
Emergency Medicine ◽  
Clinical Symptoms ◽  
Normal Adult ◽  
Lateral Ventricles ◽  
Asymptomatic Adult ◽  
Neurologically Normal ◽  
Made In

Colpocephaly is a form of congenital ventriculomegaly characterized by enlarged occipital horns of the lateral ventricles with associated neurologic abnormalities. The diagnosis of colpocephaly is typically made in infancy. Its diagnosis in adulthood without associated clinical symptoms is exceptionally rare. We report a case of colpocephaly diagnosed incidentally in an adult without neurologic abnormalities in the emergency department. To our knowledge, this is only the ninth reported case in an asymptomatic adult and the first to be described in the emergency medicine literature.

scholarly journals Lipid therapy for the treatment of a refractory amitriptyline overdose

CJEM ◽  
2012 ◽  
Vol 14 (03) ◽  
pp. 193-197 ◽  
Author(s):  
Mathew B. Kiberd ◽  
Samuel F. Minor
Keyword(s):  
Lipid Emulsion ◽  
Case Reports ◽  
Hemodynamic Instability ◽  
Tricyclic Antidepressant ◽  
Intentional Ingestion ◽  
Wide Complex Tachycardia ◽  
Whole Bowel Irrigation ◽  
Level Of Consciousness ◽  
Amitriptyline Overdose ◽  
Multiple Episodes

ABSTRACT Tricyclic antidepressant (TCA) overdose is a leading cause of death among intentional overdoses. Intravenous lipid emulsion therapy is an emerging antidote for local anesthetic toxicity, and there is animal evidence that lipid therapy may be efficacious in TCA overdose. Furthermore, case reports in humans have described the use of lipid therapy to reverse the toxicity of other lipophilic drugs. Here we report a 25-year-old female presenting with coma and hemodynamic instability following intentional ingestion of amitriptyline. She had multiple episodes of pulseless wide-complex tachycardia despite conventional treatment with chest compressions, cardioversion, lidocaine, epinephrine, norepinephrine, magnesium sulphate, sodium bicarbonate, activated charcoal, and whole bowel irrigation. Twenty percent lipid emulsion was administered intravenously (an initial 150 mL bolus, followed by an infusion at 16 mL/h and a second bolus of 40 mL) over 39 hours (total dose 814 mL) yet resulted in no dramatic changes in hemodynamics or level of consciousness. However, there was a decrease in the frequency of wide-complex tachycardia during the lipid emulsion infusion and a recurrence of wide-complex tachycardia shortly after the infusion was stopped. The patient was discharged from the intensive care unit 11 days later with no lasting physiologic sequelae.

scholarly journals Emergency department preparation for COVID-19: accelerated care units

2020 ◽  
Vol 37 (7) ◽  
pp. 402-406 ◽  
Author(s):  
Jeanne Noble ◽  
Nida Felicija Degesys ◽  
Elizabeth Kwan ◽  
Edward Grom ◽  
Cortlyn Brown ◽  
...  
Keyword(s):  
Emergency Department ◽  
San Francisco ◽  
Negative Pressure ◽  
Potential Model ◽  
Adaptive Leadership ◽  
Protective Equipment ◽  
The Novel ◽  
Leadership Challenges ◽  
Novel Coronavirus ◽  
Rapid Deployment

By 11 February 2020 when the WHO named the novel coronavirus (SARS-CoV-2) and the disease it causes (COVID-19), it was evident that the virus was spreading rapidly outside of China. Although San Francisco did not confirm its first locally transmitted cases until the first week of March, our ED and health system began preparing for a potential COVID-19 surge in late February 2020.In this manuscript, we detail how the above responses were instrumental in the rapid deployment of two military-grade negative-pressure medical tents, named accelerated care units (ACU). We describe engagement of our workforce, logistics of creating new care areas, ensuring safety through personal protective equipment access and conservation, and the adaptive leadership challenges that this process posed.We know of no other comprehensive examples of how EDs have prepared for COVID-19 in the peer-reviewed literature. Many other EDs both in and outside of California have requested access to the details of how we operationalised our ACUs to facilitate their own planning. This demonstrates the urgent need to disseminate this information to our colleagues. Below we describe the process of developing and launching our ACUs as a potential model for other EDs around the country.

Feasibility of phenytoin as a paramedic-led second-line anti-epileptic drug

2020 ◽  
Vol 12 (9) ◽  
pp. 349-353
Author(s):  
Luke Morrison
Keyword(s):  
Emergency Department ◽  
Literature Search ◽  
Standard Of Care ◽  
Medical Emergency ◽  
Convulsive Status Epilepticus ◽  
Second Line ◽  
Search Terms ◽  
Anti Epileptic Drug ◽  
Health Community ◽  
Almost All

Background: Convulsive status epilepticus (CSE) is a medical emergency that is commonly encountered in the prehospital setting. In almost all prehospital settings, treatment is limited to benzodiazepines even though the standard of care in emergency departments includes second-line agents such as phenytoin. Methods: A literature search was conducted using PubMed and Google Scholar using the search terms ‘phenytoin’, ‘seizure’ or ‘convulsive’ and ‘prehospital’, ‘EMS’ or ‘ambulance’ or ‘emergency department’. Five articles were analysed and a narrative review formed. Results: Phenytoin is an effective and commonly used second-line anti-epileptic agent but there is a distinct lack of evidence on prehospital phenytoin. Phasing the introduction of phenytoin into practice while simultaneously running a well-designed research trial could provide data for prehospital providers and the wider health community. Conclusion: Management of CSE will continue to present challenges to prehospital providers. Promoting the introduction of phenytoin to select patients, administered by advanced clinicians, could be an excellent opportunity to generate much-needed clinical data and potentially reduce morbidity and mortality in CSE.

Coronavirus disease 2019 (COVID-19): a new challenge in untreated wastewater

2020 ◽  
Vol 47 (8) ◽  
pp. 1005-1009 ◽  
Author(s):  
Akshay Kumar Chaudhry ◽  
Payal Sachdeva
Keyword(s):  
Human Health ◽  
Human Exposure ◽  
Etiologic Agent ◽  
Decision Makers ◽  
The Novel ◽  
Successful Management ◽  
Virus Shedding ◽  
Untreated Wastewater ◽  
Novel Coronavirus

COVID-19 outbreak was declared a pandemic by the WHO on 12 March 2020. As of 27 May 2020, WHO statistics exhibited that more than five million confirmed cases have been reported globally. Much remains unclear about the fate and impact of SARS-CoV-2, the novel coronavirus 2019, in wastewater. SARS-CoV-2 infection, the etiologic agent of the current COVID-19 pandemic, is followed by virus shedding in the stool. The quantification of SARS-CoV-2 in wastewater, therefore, enables monitoring of the prevalence of infections among the population through wastewater-based epidemiology. This review discusses the possible spread of the SARS-CoV-2 virus in wastewater and its impact on human health, if any. The information and resources outlined in this paper are based on recently published studies and provide information to decision-makers on the successful management of COVID-19 and reduce the risk of human exposure to COVID-19. Additionally, systems-based approaches to curtail COVID-19 spread are also discussed.

scholarly journals Subacute Thyroiditis from COVID-19 Infection: A Case Report and Review of Literature

2020 ◽  
pp. 1-5
Author(s):  
Akshay Khatri ◽  
Esti Charlap ◽  
Angela Kim
Keyword(s):  
Clinical Features ◽  
Clinical Laboratory ◽  
Early Recognition ◽  
Subacute Thyroiditis ◽  
The Novel ◽  
Review Of Literature ◽  
Successful Management ◽  
Case Presentation ◽  
Radiologic Findings ◽  
History Of

<b><i>Introduction:</i></b> The novel severe-acute-respiratory-syndrome-coronavirus-2 (SARS-CoV-2) virus has led to the ongoing Coronavirus disease 2019 (COVID-19) disease pandemic. There are increasing reports of extrapulmonary clinical features of COVID-19, either as initial presentations or sequelae of disease. We report a patient diagnosed with subacute thyroiditis precipitated by COVID-19 infection, as well as review the literature of similar cases. <b><i>Case Presentation:</i></b> A 41-year-old female with no significant personal or family history of endocrinologic disorders presented with clinical features of thyroiditis that began after COVID-19 infection. Clinical, laboratory, and radiologic findings were indicative of subacute thyroiditis. Workup for potential triggers other than SARS-CoV-2 was negative. <b><i>Discussion/Conclusion:</i></b> We compared the clinical and diagnostic findings of our patient with other well-documented cases of subacute thyroiditis presumed to be triggered by SARS-CoV-2 viral infection. We also reviewed the literature related to the potential mechanisms leading to thyroiditis. Clinicians must be aware of the possibility of thyroid dysfunction after COVID-19 infection. Early recognition and timely anti-inflammatory therapy help in successful management.

scholarly journals Abdominal symptoms as an initial manifestation of COVID-19 infection: Report of two cases

2020 ◽  
Author(s):  
PATRÍCIA YOKOO ◽  
Eduardo Kaiser Ururahy Nunes Fonseca ◽  
Marcelo Oranges Filho ◽  
Rodrigo Caruso Chate ◽  
Gilberto Szarf ◽  
...  
Keyword(s):  
Emergency Department ◽  
Respiratory Symptoms ◽  
Early Stage ◽  
The Novel ◽  
Initial Finding ◽  
Initial Manifestation ◽  
Abdominal Symptoms ◽  
Novel Coronavirus ◽  
Lung Base

Abstract The novel coronavirus (COVID-19) pandemic started in December 2019 in Wuhan (Hubei, China) and spread rapidly; therefore, it is essential to detect the disease at an early stage and immediately isolate the infected patients [1]. The most common symptoms of COVID-19 infection include fever, asthenia, cough and dyspnea [2]. However, some patients are asymptomatic from the respiratory symptoms, and may only present abdominal manifestations as an initial finding, what creates a diagnostic challenge.We describe two cases with diagnostic confirmations of COVID-19 who showed up at the Emergency Department with abdominal symptoms before presenting respiratory manifestations, and who had their initial suspicion based on the findings of the thoracoabdominal transition, demonstrating the importance of an adequate assessment of the lung base images.

scholarly journals Case Report: Disposition of Symptomatic Probable COVID-19

2020 ◽  
Vol 4 (3) ◽  
pp. 336-339
Author(s):  
Aleq Jaffery ◽  
John Slakey ◽  
David Zodda ◽  
Douglas Finefrock
Keyword(s):  
Emergency Department ◽  
Case Report ◽  
Distress Syndrome ◽  
Healthcare Providers ◽  
The Novel ◽  
Moderate Risk ◽  
Risk Of Progression ◽  
Novel Coronavirus ◽  
Tools And Techniques

Introduction: The novel coronavirus disease 2019 (COVID-19) presents a challenge for healthcare providers in terms of diagnosis, management, and triage of cases requiring admission. Case Report: A 47-year-old male with symptoms suspicious for COVID-19, pulse oximetry of 93% on room air, and multifocal pneumonia was risk stratified and safely discharged from the emergency department (ED) despite having moderate risk of progression to acute respiratory distress syndrome. He had resolution of his symptoms verified by telephone follow-up. Conclusion: Various risk-stratifying tools and techniques can aid clinicians in identifying COVID-19 patients who can be safely discharged from the ED.

Who should treat epistaxis?

1987 ◽  
Vol 101 (2) ◽  
pp. 139-142 ◽  
Author(s):  
D. G. John ◽  
A. I. Alison ◽  
D. J. A. Scott ◽  
A. R. McRae ◽  
M. J. Allen
Keyword(s):  
Emergency Department ◽  
General Practitioner ◽  
Prospective Study ◽  
Successful Treatment ◽  
Successful Management ◽  
Bleeding Point ◽  
Accident And Emergency ◽  
Accident And Emergency Department ◽  
A Prospective Study

AbstractA prospective study was undertaken of 75 patients complaining of epistaxis who presented to an Accident and Emergency Department.The patients were placed into four groups according to their presenting features, and various forms of appropriate management applied.It was found that in the group that had ceased bleeding on presentation, whether or not a bleeding point was visible, there was no benefit obtained by treatment. If the nose was still bleeding on presentation, and the bleeding point was visible, successful management could be obtained by cauterising the bleeding point. This is a treatment that could be carried out by either the General Practitioner or the Accident Department. If the nose was actively bleeding, and the bleeding point could not be seen, then even initially successful treatment by the Accident Department was usually found to be ineffective within forty-eight hours. It is suggested that this group should be referred to an ENT unit on presentation.

Sign in / Sign up

Export Citation Format

Share Document