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1.
J Emerg Med ; 59(2): e43-e47, 2020 Aug.
Article in English | MEDLINE | ID: mdl-32536493

ABSTRACT

BACKGROUND: Flecainide is a class Ic antidysrhythmic agent used to prevent and treat both ventricular and supraventricular tachycardias, including atrial fibrillation, atrioventricular nodal re-entrant tachycardia, and Wolff-Parkinson-White syndrome. Flecainide can cause serious side effects, including cardiac arrest, dysrhythmias, and heart failure. Despite its growing use, the presenting signs and symptoms of flecainide toxicity are not familiar to most clinicians. In particular, our patient's particular presentation of acute kidney injury (AKI) resulting in flecainide accumulation is high risk for missed diagnosis in the emergency department. CASE REPORT: A 58-year-old woman presented with altered mental status and hypoxia that was later found to be secondary to sepsis. Medical history was notable for atrial fibrillation, for which she was on flecainide. Laboratory results were notable for hypokalemia and an AKI. Her wide complex tachycardia on admission was ultimately attributed to flecainide toxicity in the setting of AKI. Six days after presentation, it was found that her flecainide level was in the toxic range at 2.02 µg/mL (normal range 0.20-1.00 µg/mL, toxic >1.50 µg/mL). WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Flecainide intoxication is rare but serious due to the potential for cardiogenic shock. Its diagnosis can be difficult, as the flecainide serum level may take days to result. This case demonstrates the necessity of keeping flecainide toxicity on the physician's differential for patients who are taking the drug, as well as what electrocardiogram findings suggest it as the etiology. Treatment can be lifesaving if initiated promptly.


Subject(s)
Atrial Fibrillation , Tachycardia, Supraventricular , Tachycardia, Ventricular , Wolff-Parkinson-White Syndrome , Anti-Arrhythmia Agents/toxicity , Atrial Fibrillation/drug therapy , Electrocardiography , Female , Flecainide , Humans , Middle Aged , Tachycardia, Supraventricular/drug therapy , Tachycardia, Ventricular/drug therapy
3.
J Emerg Med ; 43(6): 1063-5, 2012 Dec.
Article in English | MEDLINE | ID: mdl-22525695

ABSTRACT

BACKGROUND: Bedside ultrasound in the emergency department is being used with increasing frequency and for an increasing scope of conditions. OBJECTIVES: Demonstrate the use of bedside ultrasound as an adjunct for diagnosis of hip dislocation. CASE REPORT: A traumatic anterior hip dislocation was diagnosed with bedside ultrasound after an initial normal plain radiograph. CONCLUSION: Although the current standard of care for diagnosis of hip dislocation is plain radiographs, this case demonstrates that bedside ultrasound may be used as a diagnostic adjunct in this time-sensitive and potentially catastrophic diagnosis.


Subject(s)
Emergency Service, Hospital , Hip Dislocation/diagnostic imaging , Point-of-Care Systems , Humans , Male , Middle Aged , Radiography , Ultrasonography
4.
Ann Emerg Med ; 46(2): 142-7, 2005 Aug.
Article in English | MEDLINE | ID: mdl-16046943

ABSTRACT

STUDY OBJECTIVE: We seek to determine the amount and type of work-related violence experienced by Michigan attending emergency physicians. METHODS: A mail survey of self-reported work-related violence exposure during the preceding 12 months was sent to randomly selected emergency physician members of the Michigan College of Emergency Physicians. Work-related violence was defined as verbal, physical, confrontation outside of the emergency department (ED), or stalking. RESULTS: Of 250 surveys sent, 177 (70.8%) were returned. Six were blank (3 were from retired emergency physicians), leaving 171 (68.4%) for analysis. Verbal threats were the most common form of work-related violence, with 74.9% (95% confidence interval [CI] 68.4% to 81.4%) of emergency physicians indicating at least 1 verbal threat in the previous 12 months. Of the emergency physicians responding, 28.1% (95% CI 21.3% to 34.8%) indicated that they were victims of a physical assault, 11.7% (95% CI 6.9% to 16.5%) indicated that they were confronted outside of the ED, and 3.5% (95% CI 0.8% to 6.3%) experienced a stalking event. Emergency physicians who were verbally threatened tended to be less experienced (11.1 versus 15.1 years in practice; mean difference -4.0 years [95% CI -6.4 to -1.6 years]), as were those who were physically assaulted (9.5 versus 13.1 years; mean difference -3.6 years [95% CI -5.9 to -1.3 years]). Urban hospital location, emergency medicine board certification, or on-site emergency medicine residency program were not significantly associated with any type of work-related violence. Female emergency physicians were more likely to have experienced physical violence (95% CI 1.4 to 5.8) but not other types of violence. Most (81.9%; 95% CI 76.1% to 87.6%) emergency physicians were occasionally fearful of workplace violence, whereas 9.4% (95% CI 5.0% to 13.7%) were frequently fearful. Forty-two percent of emergency physicians sought various forms of protection as a result of the direct or perceived violence, including obtaining a gun (18%), knife (20%), concealed weapon license (13%), mace (7%), club (4%), or a security escort (31%). CONCLUSION: Work-related violence exposure is not uncommon in EDs. Many emergency physicians are concerned about the violence and are taking measures, including personal protection, in response to the fear.


Subject(s)
Emergency Service, Hospital/statistics & numerical data , Medical Staff, Hospital/statistics & numerical data , Violence/statistics & numerical data , Fear , Female , Humans , Incidence , Male , Medical Staff, Hospital/psychology , Michigan/epidemiology , Security Measures , Surveys and Questionnaires , Workplace
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