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Critical Care

Etomidate as an Induction Agent in Septic Patients: Red Flags or False Alarms?

Despite its widespread use in North America and many other parts of the world, the safety of etomidate as an induction agent for rapid sequence intubation in septic patients is still debated. In this article, we evaluate the current literature on etomidate, review its clinical history, and discuss the controversy regarding its use, especially in sepsis. We address eight questions

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Critical Care

Cocaine-Associated Seizures and Incidence of Status Epilepticus

Acute complications from cocaine abuse are commonly treated in the emergency department (ED); one of the most consequential is status epilepticus. The incidence of this complication is not clearly defined in the prior literature on cocaine-associated sequelae. We evaluated the incidence of status epilepticus in patients with seizures secondary to suspected cocaine use.

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Methemoglobinemia and Sulfhemoglobinemia in Two Pediatric Patients after Ingestion of Hydroxylamine Sulfate

This case report describes two pediatric cases of immediate oxygen desaturation from methemoglobinemia and sulfhemoglobinemia after one sip from a plastic water bottle containing hydroxylamine sulfate used by a relative to clean shoes. Supplemental oxygen and two separate doses of methylene blue given to one of the patients had no effect on clinical symptoms or pulse oximetry. The patients were admitted to the pediatric Intensive Care Unit (ICU) with subsequent improvement after exchange transfusion. Endoscopy showed ulcer formation in one case and sucralafate was initiated; both patients were discharged after a one-week hospital stay.

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Fatal Metformin Overdose Presenting with Progressive Hyperglycemia

A 29-year-old man with no history of diabetes ingested over 60 grams of metformin in a suicide attempt. He presented to the emergency department with acute renal insufficiency, severe lactic acidosis, and rapidly-progressive hyperglycemia. The patient’s peak serum glucose level of 707 mg/dL is the highest yet reported in a case of metformin toxicity. Treatment included sodium bicarbonate infusion and hemodialysis, but the patient suffered several cardiac arrests with pulseless electrical activity and ultimately expired 25 hours after the ingestion.

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Fluoxetine Overdose-Induced Seizure

A 37-year-old woman experienced a witnessed generalized seizure in the Emergency Department three hours after ingesting approximately 1400 mg of fluoxetine in a suicide attempt. Although the majority of fluoxetine ingestions are benign, seizures may occur after large intentional overdoses.

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WestJEM/ Department of Emergency Medicine
UC Irvine Health

333 The City Blvd. West, Rt 128-01
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Orange, CA 92868, USA
Phone: 1-714-456-6389
Email: editor@westjem.org

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WestJEM
ISSN: 1936-900X
e-ISSN: 1936-9018

CPC-EM
ISSN: 2474-252X

Our Philosophy

Emergency Medicine is a specialty which closely reflects societal challenges and consequences of public policy decisions. The emergency department specifically deals with social injustice, health and economic disparities, violence, substance abuse, and disaster preparedness and response. This journal focuses on how emergency care affects the health of the community and population, and conversely, how these societal challenges affect the composition of the patient population who seek care in the emergency department. The development of better systems to provide emergency care, including technology solutions, is critical to enhancing population health.