What’s New in June for Emergency Medicine features:

– Antidote to Anticholinergic Toxicity

– Status Epilepticus

– Enemas in Constipation

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Anticholinergic Toxicity

Jeffrey T. Lai, MD

Department of Emergency Medicine, University of Massachusetts Medical School, Worcester, MA

Kavita M. Babu, MD

Division of Medical Toxicology, Department of Emergency Medicine, University of Massachusetts Medical School, Worcester, MA

 

Antidote to Anticholinergic Toxicity

Physostigmine is an effective antidote that can be considered in selected adult and pediatric cases when there is severe anticholinergic toxicity from ingestions as varied as over-the-counter antihistamines, tricyclic antidepressant overdose, and atypical antipsychotic overdoses. The decision to use physostigmine should be made in conjunction with a medical toxicologist. It should be avoided in actively seizing patients or patients with evidence of hemodynamic compromise. Evidence suggests that the majority of patients will only require one dose and that extended repeat dosing is uncommon.

 


 

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Progression of selected neuronal pathophysiologic mechanisms involved over time during and after status epilepticus.

 

Seizure

Robert Silbergleit, MD
Neurological Emergencies Research, Department of Emergency Medicine, Ann Arbor, MI

 

Status Epilepticus

Status epilepticus has a distinct pathophysiology that remains poorly understood; interestingly, in animal models, many of the basic underlying mechanisms appear to be common regardless of how seizures are initiated. A single seizure is transformed into a self-perpetuating and pharmacoresistant disorder through a cascade of extrinsic signaling followed by intrinsic nuclear events. Initial treatment for both children and adults consists of intramuscular midazolam, intravenous lorazepam, or intravenous diazepam, with repeat dosing after 10 minutes if the convulsions persist.

 


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Abdominal x-ray demonstrating air-fluid levels; arrow, air in a small loop of distal small bowel.

 

Constipation in the Emergency Department

Jamie Santistevan, MD
Department of Emergency Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI
Ciara J Barclay-Buchanan, MD, FACEP
Department of Emergency Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI
Mary C Westergaard, MD, FACEP
Department of Emergency Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI

 

Enemas in Constipation

Enemas involve instilling fluid into the colon through the rectum, and work by softening the stool, distending the lumen of the bowel, and inducing colonic contractions. Enemas should be used sparingly in the treatment of constipation. They can be used after manual fecal disimpaction for bowel cleansing or to prevent impaction after several days of constipation. Sodium phosphate enemas have been associated with volume and electrolyte disturbances, including hyperphosphatemia and renal failure, and there have been several reports of death associated with their use. The use of sodium phosphate enemas should be avoided in the very young and very old because of these associated side effects.

 

 


 

As seen in Scientific AmericanTM Emergency Medicine,teaching principles and practice of Emergency Medicine.