Alcohol and trauma—in every age group Terry Kowalenko, Bradford Burgess, Susanna M. Szpunar, Charlene B. Irvin-Babcock
DOI: http://dx.doi.org/10.1016/j.ajem.2012.12.032
The American Journal of Emergency Medicine , Vol. 31 , Issue 4 ,
Published online: February 4 2013
x The purpose was to determine the proportion of alcohol-positive (AlcPos) trauma patients in different age groups and any association with mortality using the National Trauma Data Bank.
Using process indicators to optimize service completion of an ED drug and alcohol brief intervention program Joanna Akin, J. Aaron Johnson, J. Paul Seale, Gabriel P. Kuperminc
DOI: http://dx.doi.org/10.1016/j.ajem.2014.10.021
The American Journal of Emergency Medicine , Vol. 33 , Issue 1 ,
Published online: October 21 2014
x The strongest evidence for effectiveness of screening, brief intervention, and referral to treatment (SBIRT) programs is in primary care settings. Emergency department (ED) studies have shown mixed results. Implementation of SBIRT into ED settings is complicated by the type of patients seen and the fast-paced, high-throughput nature of the ED environment that makes it difficult to reach patients flagged for SBIRT services. This study uses data from an ED-based SBIRT program to examine the relationship between screen-positive rate, ED patient flow, and SBIRT service delivery.
Naproxen-induced methemoglobinemia in an alcohol-dependent patient Won Suk Lee, Jang Young Lee, Won Young Sung, Sang Won Seo
DOI: http://dx.doi.org/10.1016/j.ajem.2014.04.027
The American Journal of Emergency Medicine , Vol. 32 , Issue 11 ,
Published online: April 17 2014
x The authors report a case of acute methemoglobinemia in a patient treated with naproxen for the common cold. A 42-year-old Asian woman began taking naproxen sodium and methocarbamol for mylagia, chills, and coughing. On the day prior to her emergency department (ED) admission, the patient was taking lorazepam, trazodon, and paroxetine in addition to the naproxen and methocarbamol prescribed for the cold symptoms, and she also ingested approximately 300 mL of 20% alcohol. Upon awakening the next morning, the patient experienced dyspnea and dizziness.
Frequent ED users: are most visits for mental health, alcohol, and drug-related complaints? Shan W. Liu, John T. Nagurney, Yuchiao Chang, Blair A. Parry, Peter Smulowitz, Steven J. Atlas
DOI: http://dx.doi.org/10.1016/j.ajem.2013.08.006
The American Journal of Emergency Medicine , Vol. 31 , Issue 10 ,
Published online: September 12 2013
x To determine whether frequent emergency department (ED) users are more likely to make at least one and a majority of visits for mental health, alcohol, or drug-related complaints compared to non-frequent users.
The Effect of Ethanol on Lactate and Base Deficit as Predictors of Morbidity and Mortality in Trauma Mark L. Gustafson, Steve Hollosi, Julton Tomanguillo Chumbe, Damayanti Samanta, Asmita Modak, Audis Bethea
DOI: http://dx.doi.org/10.1016/j.ajem.2015.01.030
The American Journal of Emergency Medicine , Vol. 33 , Issue 5 ,
Published online: January 22 2015
x The objective of this study was to assess the predictive value of lactate and base deficit in determining outcomes in trauma patients who are positive for ethanol.
Pediatric occult methanol intoxication with hyperammonemia Dazhe Cao, Aline B. Maddux, Danielle Mashburn, Christine Vohwinkel, George S. Wang
DOI: http://dx.doi.org/10.1016/j.ajem.2015.06.031
The American Journal of Emergency Medicine , Vol. 34 , Issue 2 ,
Published online: June 17 2015
x A 17-year-old girl presented with one week of fatigue, dyspnea and chest pain. Initial vitals were temperature 36 °C, heart rate 113, blood pressure 127/78, respiratory rate 56, and oxygen saturation 95%. Initial exam was notable for mydriasis and tachypnea. Laboratory tests were significant for bicarbonate level <
ED disposition of the Glasgow Coma Scale 13 to 15 traumatic brain injury patient: analysis of the Transforming Research and Clinical Knowledge in TBI study Jonathan J. Ratcliff, Opeolu Adeoye, Christopher J. Lindsell, Kimberly W. Hart, Arthur Pancioli, Jason T. McMullan, John K. Yue, Daniel K. Nishijima, and others
DOI: http://dx.doi.org/10.1016/j.ajem.2014.04.003
The American Journal of Emergency Medicine , Vol. 32 , Issue 8 ,
Published online: April 14 2014
x Mild traumatic brain injury (mTBI) patients are frequently admitted to high levels of care despite limited evidence suggesting benefit. Such decisions may contribute to the significant cost of caring for mTBI patients. Understanding the factors that drive disposition decision making and how disposition is associated with outcomes is necessary for developing an evidence-base supporting disposition decisions. We evaluated factors associated with emergency department triage of mTBI patients to 1 of 3 levels of care: home, inpatient floor, or intensive care unit (ICU).
A rational approach to the treatment of alcohol withdrawal in the ED Christine R. Stehman, Mark B. Mycyk
DOI: http://dx.doi.org/10.1016/j.ajem.2012.12.029
The American Journal of Emergency Medicine , Vol. 31 , Issue 4 ,
Published online: February 11 2013
x Approximately 7% of the US population abuses or is dependent on alcohol. Patients with alcohol disorders often seek medical attention in Emergency Departments (EDs) for complications directly related to alcohol use or due to other medical issues associated with alcohol use. Because of increasing lengths of stay in EDs, alcohol-dependent patients are at high risk of developing alcohol withdrawal syndrome (AWS) during their ED visit. This article reviews the physiology of alcohol withdrawal as well as the symptoms of this potentially deadly illness for the practicing emergency physician (EP).
Is arterial base deficit still a useful prognostic marker in trauma? A systematic review I. Ibrahim, W.P. Chor, K.M. Chue, C.S. Tan, H.L. Tan, F.J. Siddiqui, M. Hartman
DOI: http://dx.doi.org/10.1016/j.ajem.2015.12.012
The American Journal of Emergency Medicine , Vol. 34 , Issue 3 ,
Published online: December 14 2015
x Arterial base deficit (BD) has been widely used in trauma patients since 1960. However, trauma management has also evolved significantly in the last 2 decades. The first objective of this study was to systematically review the literature on the relationship between arterial BD as a prognostic marker for trauma outcomes (mortality, significant injuries, and major complications) in the acute setting. The second objective was to evaluate arterial BD as a prognosis marker, specifically, in the elderly and in patients with positive blood alcohol levels.
Subject Index
DOI: http://dx.doi.org/10.1016/S0735-6757(15)00997-3
The American Journal of Emergency Medicine , Vol. 33 , Issue 12 ,
Published in issue: December 2015
A pilot study of emergency medical technicians' field assessment of intoxicated patients' need for ED care Alexandra H. Cornwall, Nickolas Zaller, Otis Warren, Kenneth Williams, Nina Karlsen-Ayala, Brian Zink
DOI: http://dx.doi.org/10.1016/j.ajem.2011.06.004
The American Journal of Emergency Medicine , Vol. 30 , Issue 7 ,
Published online: November 7 2011
x Alcohol–intoxicated individuals account for a significant proportion of emergency department care and may be eligible for care at alternative sobering facilities. This pilot study sought to examine intermediate-level emergency medical technician (EMT) ability to identify intoxicated individuals who may be eligible for diversion to an alternative sobering facility.
Visits by the elderly to United States EDs for alcohol-related disorders Allison Tadros, Meredith Mason, Danielle M. Davidov, Stephen M. Davis, Shelley M. Layman
DOI: http://dx.doi.org/10.1016/j.ajem.2015.04.032
The American Journal of Emergency Medicine , Vol. 33 , Issue 9 ,
Published online: April 24 2015
x The objectives are to estimate the number of elderly patients presenting to emergency departments (EDs) in the United States from 2006 to 2011 for alcohol-related disorders and examine their demographic and clinical features.
Fomepizole for severe disulfiram-ethanol reactions Margaret Sande, David Thompson, Andrew A. Monte
DOI: http://dx.doi.org/10.1016/j.ajem.2010.11.014
The American Journal of Emergency Medicine , Vol. 30 , Issue 1 ,
Published online: January 5 2011
x Ingestion of ethanol in the presence of disulfiram may cause a histamine-like reaction due to accumulation of acetaldehyde. These disulfiram-ethanol reactions (DERs) are manifested by hypotension, tachycardia, gastritis, and angioedema. Fomepizole, an inhibitor of alcohol dehydrogenase, may halt progression of this reaction by blocking ethanol metabolism to acetaldehyde. We present 2 cases of disulfiram and alcohol overdose leading to severe reactions unresponsive to fluid resuscitation and treated with a single dose of fomepizole.
Therapeutic hypothermia: a state-of-the-art emergency medicine perspective Joseph Varon, Paul E. Marik, Sharon Einav
DOI: http://dx.doi.org/10.1016/j.ajem.2011.03.007
The American Journal of Emergency Medicine , Vol. 30 , Issue 5 ,
Published online: May 13 2011
x Therapeutic hypothermia (TH) has gained popularity as a brain-protective strategy for victims of sudden cardiac death in whom return of spontaneous circulation has been achieved but coma persists. Trials have also demonstrated some advantageous effects of lowering core body temperature after stroke and hypoxic-ischemic encephalopathy of the newborn. In a variety of clinical conditions, TH is still being studied (eg, hepatic encephalopathy and traumatic brain injury). This study describes the historical development of TH, its current applications in emergency medicine, and its potential future uses.
Disulfiram ethanol reaction mimicking anaphylactic, cardiogenic, and septic shock Simon Bourcier, Nicolas Mongardon, Fabrice Daviaud, Laurence Moachon, Marc-Antoine Arnould, Franck Perruche, Frédéric Pène, Alain Cariou
DOI: http://dx.doi.org/10.1016/j.ajem.2012.05.002
The American Journal of Emergency Medicine , Vol. 31 , Issue 1 ,
Published online: July 18 2012
x Shock is a common reason for medical intensive care unit admission, with septic and cardiogenic accounting for most of the etiologies. However, the potential severity of adverse side effects of drugs indicates that any medication should be carefully scrutinized for potential pharmacokinetic and pharmacodynamic interactions that may result. We herein report the case of a life-threatening shock mimicking successively anaphylactic, cardiogenic, and septic shock, which was finally related to disulfiram ethanol reaction.
Sex and age differences in ED patients with mental and behavioral disorders due to psychoactive substance use Fanny Le Querrec, Vincent Bounes, Maryse Lapeyre Mestre, Olivier Azema, Nicolas Longeaux, Jean-Christophe Gallart
DOI: http://dx.doi.org/10.1016/j.ajem.2015.06.068
The American Journal of Emergency Medicine , Vol. 33 , Issue 11 ,
Published online: July 6 2015
x The objectives of this study are to describe an emergency department (ED) adult population with the chief complaint of mental and behavioral disorders due to psychoactive substance use and to investigate sex- and age-related differences.
A description of Medical Examiner prescription-related deaths and prescription drug monitoring program data Roneet Lev, Sean Petro, Oren Lee, Jonathan Lucas, Amy Stuck, Gary M. Vilke, Edward M. Castillo
DOI: http://dx.doi.org/10.1016/j.ajem.2015.12.023
The American Journal of Emergency Medicine , Vol. 34 , Issue 3 ,
Published online: December 14 2015
x The Centers of Disease Control and Prevention have declared prescription drug abuse an epidemic in the United States. However, demographic data correlating prescription-related deaths with actual prescriptions written is not well described. The purpose of this study is to compare toxicology reports on autopsy for prescription-related deaths with Prescription Drug Monitor Program (PDMP) data.
Respiratory depression in the intoxicated trauma patient: are opioids to blame? Eleni Shenk, Cassie A. Barton, Nathan D. Mah, Ran Ran, Robert G. Hendrickson, Jennifer Watters
DOI: http://dx.doi.org/10.1016/j.ajem.2015.10.053
The American Journal of Emergency Medicine , Vol. 34 , Issue 2 ,
Published online: November 3 2015
x Providing effective pain management to acutely intoxicated trauma patients represents a challenge of balancing appropriate pain management with the risk of potential respiratory depression from opioid administration. The objective of this study was to quantify the incidence of respiratory depression in trauma patients acutely intoxicated with ethanol who received opioids as compared with those who did not and identify potential risk factors for respiratory depression in this population. Retrospective medical record review was conducted for subjects identified via the trauma registry who were admitted as a trauma activation and had a detectable serum ethanol level upon admission.
A prospective, randomized, trial of phenobarbital versus benzodiazepines for acute alcohol withdrawal Gregory W. Hendey, Robert A. Dery, Randy L. Barnes, Brandy Snowden, Philippe Mentler
DOI: http://dx.doi.org/10.1016/j.ajem.2009.10.010
The American Journal of Emergency Medicine , Vol. 29 , Issue 4 ,
Published online: March 26 2010
x The aim of this study was to compare phenobarbital (PB) versus lorazepam (LZ) in the treatment of alcohol withdrawal in the emergency department (ED) and at 48 hours.
Clinical predictors for delirium tremens in patients with alcohol withdrawal seizures Dong Wook Kim, Hyun Kyung Kim, Eun-Kee Bae, So-Hee Park, Kwang Ki Kim
DOI: http://dx.doi.org/10.1016/j.ajem.2015.02.030
The American Journal of Emergency Medicine , Vol. 33 , Issue 5 ,
Published online: February 23 2015
x Delirium tremens (DT) is the severest form of alcohol withdrawal syndrome, frequently after alcohol withdrawal seizures. Delirium tremens occurs in a small proportion of patients with alcohol withdrawal seizures; nevertheless, early identification of high-risk patients is important for intensive preventive management of unexpected episodes due to agitation and its associated increased mortality. However, there are limited studies on clinical predictors of the development of DT in patients with alcohol withdrawal seizures.
