Identifying trigger concepts to screen emergency department visits for diagnostic errors.

Objectives: The diagnostic process is a vital component of safe and effective emergency department (ED) care. There are no standardized methods for identifying or reliably monitoring diagnostic errors in the ED, impeding efforts to enhance diagnostic safety. We sought to identify trigger concepts to screen ED records for diagnostic errors and describe how they can be used as a measurement strategy to identify and reduce preventable diagnostic harm.

A pilot study on the management and outcomes of self-poisoning in a rural Ugandan Emergency Centre.

Introduction: The Global Emergency Care Collaborative and Nyakibale Hospital in Rukungiri opened the first functional emergency centre in rural Uganda. We investigated decontamination, management and outcomes of poisoned patients in the emergency centre.

Methods: An electronic database started recording charts from 24 March 2012.

Management of severe bupropion poisoning with intravenous lipid emulsion.

Background: Bupropion toxicity is characterized by central nervous system and cardiovascular toxicity. Intravenous lipid emulsion (ILE) has been suggested as a treatment by some for the treatment of refractory bupropion toxicity. This recommendation is based largely on published case reports and cases presented at scientific meetings.

Tapping into the wisdom in the room: results from participant discussion at the 7th International Conference on Diagnostic Error in Medicine facilitated by a World Café technique.

The patient safety literature is full of exhortations to approach medical error from a system perspective and seek multidisciplinary solutions from groups including clinicians, patients themselves, as well as experts outside the traditional medical domain. The 7th annual International Conference on Diagnostic Error in Medicine sought to attract a multispecialty audience, and attempted to capture some of the conversations by engaging participants in a World Café, a technique used to stimulate discussion and preserve insight gained during the conference. We present the ideas generated in this session, discuss them in the context of psychological safety, and demonstrate the application of this novel technique.

Haloperidol, a Novel Treatment for Cannabinoid Hyperemesis Syndrome.

Cannabinoid hyperemesis syndrome (CHS) is typically unresponsive to conventional pharmacologic antiemetics, and patients often require excessive laboratory and radiographic testing and hospital admission. We report 4 cases of CHS that failed standard emergency department therapy but improved significantly after treatment with haloperidol. Although the exact mechanism for CHS remains unclear, dysregulation at cannabinoid type 1 seems to play a role.

Those Salicylate Cases-How Sweet Are They?

Owing to the complex metabolism of salicylates, both hyperglycemia and hypoglycemia have been reported with salicylate poisoning. The aim of this study was to characterize this relationship. Data from the Illinois Poison Center were retrospectively queried over a 5-year period (2008-2012), and patients with a salicylate concentration ≥30 mg/dL were included.

Forgoing the Folate?-Contemporary Recommendations for Methanol Poisoning and Evidence Review.

Methanol poisonings can produce significant toxicity in humans, including acidosis, blindness, and death. The current mainstay of therapy is alcohol dehydrogenase (ADH) inhibition to prevent formation of formic acid and hemodialysis to correct acidosis and remove both parent compound and toxic metabolite. Folate has been recommended as an adjunctive therapy to increase formic acid oxidation into carbon dioxide and water.

Delayed elevation in carbamazepine concentrations after overdose: a retrospective poison center study.

An initial carbamazepine concentration may initially be supratherapeutic, therapeutic, or even subtherapeutic only to persist to rise over time. The aim of this study was to report the frequency of toxic carbamazepine concentrations continuing to rise and to estimate how often an initially therapeutic or subtherapeutic concentration misrepresents the potential toxicity of an acute carbamazepine overdose. An 8-year retrospective search of all carbamazepine exposures reported to the Illinois Poison Center (January 1, 2001 through December 31, 2008) was reviewed.

Ball and chain: the global burden of lead poisoning.

Lead, the 82nd element in our periodic table, has accompanied humankind throughout the millennia of our history and development. As a ubiquitous heavy metal, lead is used in multiple applications and nine billion tons continue to be extracted globally every year. Although the United States has succeeded in limiting lead exposure among its own citizens by banning the use of lead in gasoline and household paint, while instituting improved working conditions for those who are exposed to lead in the workplace, the battle against lead is not won.

Chemical and traumatic occupational eye exposures in aviation personnel.

Introduction: The eye is vulnerable to chemical exposure and foreign body infiltration in the occupational setting. Individuals working in the aviation field are prone to these types of exposures.

Methods: We conducted a 28-mo retrospective chart review to document the number of airline workers complaining of chemical or foreign body exposure to the eye at an onsite airport medical clinic.

Capitellum fracture: detecting fat pads may have a significant impact on outcome.

Capitellum fractures account for less than 1% of all elbow fractures. Their appearance on plain radiographs may be subtle. It is this combination of features that make these injuries easy to misdiagnose.

An unusual case of epistaxis-juvenile nasopharyngeal angiofibroma.

Background: Epistaxis is a common complaint seen in the younger population. Its etiology is typically from the anterior nares, although we present a case of epistaxis from an uncommon source-juvenile nasopharyngeal angiofibroma. Juvenile nasopharyngeal angiofibroma (JNA) is a highly vascular, benign, yet locally invasive tumor that occurs in preadolescent males.