Short-term impact of COVID-19 on quality of life, perceived stress, and serious psychological distress in an adult population in the midwest United States.

PURPOSE: This study aimed to investigate changes over time in quality of life, perceived stress, and serious psychological distress for individuals diagnosed with COVID-19 in an urban academic health system. METHODS: Phone-based surveys were completed with adult patients tested for COVID-19 during emergency department visits, hospitalizations, or outpatient visits at the Froedtert and Medical College of Wisconsin Health Network. Data were then matched to medical record data. Unadjusted and adjusted mixed effects linear models using random intercept were run for each outcome (physical health-related quality of life, mental health-related quality of life, perceived stress, and serious psychological distress) with time (baseline vs 3-month follow-up) as the primary independent variable. Individuals were treated as a random effect, with all covariates (age, sex, race/ethnicity, payor, comorbidity count, hospitalization, and intensive care unit (ICU) stay) treated as fixed effects. RESULTS: 264 adults tested positive for COVID-19 and completed baseline and 3-month follow-up assessments. Of that number, 31.8% were hospitalized due to COVID-19, and 10.2% were admitted for any reason to the ICU. After adjustment, patients reported higher physical health-related quality of life at 3 months compared to baseline (0.63, 95% CI 0.15, 1.11) and decreased stress at 3 months compared to baseline (- 0.85, 95% CI - 1.33, - 0.37). There were no associations between survey time and mental health-related quality of life or serious psychological distress. CONCLUSIONS: Results suggest the influence of COVID-19 on physical health-related quality of life and stress may resolve over time, however, the influence of mental health on daily activities, work, and social activities may not.

Medical student education for injury prevention: closing the gap.

INTRODUCTION: Injury is a major public health issue in the USA. In 2017, unintentional injury was the leading cause of death for ages 1 through 44. Unfortunately, there is evidence that the sciences of injury prevention and control may not fully and widely integrated into medical school curriculum. This paper describes a novel injury prevention and control summer programme that was implemented in 2002 and is ongoing. METHODS: The main component of the Series includes at least seven injury-related lectures and discussions designed to provoke students' interest and understanding of injury as a biopsychosocial disease. These lectures are organised in a seminar fashion and are 2-4 hours in duration. Kirkpatrick's four-part model guides evaluation specific to our four programme objectives. Trainee satisfaction with the programme, knowledge and outcome (specific to career goals) is evaluated using several mixed-methods tools. RESULTS: A total of 318 students have participated in the Series. Evaluation findings show an increase in knowledge of injury-related concepts as well as an increase in interest in pursuing injury-related research topics in the future. IMPLICATIONS: The Series is a novel and innovative programme that provides training in injury and injury prevention and control-related topics to medical students, as well as undergraduate, graduate and pharmacy students. We hope that by increasing students' knowledge and understanding of injury prevention and control we are contributing to a physician workforce that understands the importance of a public health approach to injury prevention, that implements public health principles in practice and that advocates for policies and practices that positively impact injury prevention and control to help make our communities healthier and safer.

A Multistep Approach to Address Clinican Knowledge, Attitudes, and Behavior Around Opioid Prescribing.

INTRODUCTION: The Wisconsin Prescription Drug Monitoring Program (PDMP) was implemented in 2013 to reduce the misuse, abuse, and diversion of controlled substance prescriptions. OBJECTIVE: To evaluate provider knowledge, attitudes, and behaviors regarding the Wisconsin PDMP before and after study interventions. METHODS: An initial survey of clinicians, a focus group, pre- and posttests for an educational session, and a 3-month follow-up survey were utilized. RESULTS: Initial survey participants described PDMP use. Focus group themes included system, hospital, clinician, and patient factors. Educational session pre- and posttests showed an increase in provider knowledge. Follow-up surveys demonstrated practice change among providers. CONCLUSION: This study can be useful for health care organizations, state PDMPs, and prevention organizations in tailoring messaging to clinicians around safe prescribing and PDMP use.

The Use of a Statewide Prescription Drug Monitoring Program by Emergency Department Physicians.

BACKGROUND: Little is known about how emergency physicians have used Wisconsin's Prescription Drug Monitoring Program (PDMP). OBJECTIVE: To characterize emergency physician knowledge and utilization of the program and how it modifies practice. METHODS: Online survey data were collected 1 year after program implementation. Descriptive statistics were generated and qualitative responses were grouped by content. RESULTS: Of the 63 respondents, 64.1% had used the program. Lack of a DEA number and knowledge about how to sign up were the most common barriers to registration. Over 97% of program users found it useful for confirming suspicion of drug abuse and 90% wrote fewer prescriptions after program implementation. Time constraints and the difficult log-in process were common barriers to use. More users than nonusers stated that their workplace was supportive of program use. CONCLUSIONS: Although barriers exist, PDMP utilization appears useful to emergency physicians and associated with modifications to patient management.

Using multiple cause-of-death data to improve surveillance of drug-related mortality.

CONTEXT: Many states and local areas are affected by the national epidemic of drug-related mortality, which recently has shown signs of a rising "licit-to-illicit drug" death ratio. Appropriate local public health surveillance can help monitor and control this epidemic. OBJECTIVE: Using our state as an example, we sought to illustrate how to describe the changes in drug death rates, causes, and circumstances. In contrast to most other surveillance reports, our approach includes both drug-induced and drug-related deaths as well as both demographic and socioeconomic characteristics of decedents. DESIGN: Cross-sectional study. SETTING: All residents of the state of Wisconsin. PARTICIPANTS: Decedents from 1999 to 2008. MAIN OUTCOME MEASURE: Annual numbers and population-based rates of deaths due to drugs, including both identified and unidentified drugs. Information was obtained from death certificates with any of approximately 270 underlying, immediate, or contributing cause-of-death codes from the International Classification of Diseases, 10th Revision. RESULTS: Drug-related death rates increased during much of the 10-year study period, and the male-to-female death ratio rose. The median age at death from drug-related causes was 43 years. Opioid analgesic poisoning surpassed cocaine and heroin poisoning as the most frequent type of fatal drug poisoning. Of all 4828 deaths from drug-related causes--virtually all of which were certified by a county medical examiner or coroner--3410 (71%) were unintentional and 1053 (22%) were suicides. The unintentional-to-suicide death rate ratio grew from 1.6 to 3.5 during the study period. Methadone-related deaths increased from 10 in 1999 to 118 in 2008 (1080%), while benzodiazepine-related deaths rose from 23 to 106 (361%). CONCLUSIONS: Although premature deaths from drug use and abuse continue to rise, even surpassing deaths due to motor vehicle crash in some states, "multiple causes of death" information from death certificates is available to monitor their occurrence and nature and to inform selection of prevention strategies.

Naloxone Prescribing in an Academic Emergency Department: Provider Practices and Attitudes.

INTRODUCTION: Naloxone reverses opioid overdose, but it is not universally prescribed. With increases in opioid-related emergency department visits, emergency medicine providers are in a unique position to identify and treat opioid-related injury, but little is known about their attitudes and practices around naloxone prescribing. We hypothesized that emergency medicine providers would identify multifactorial barriers to naloxone prescribing and report varying levels of naloxone-prescribing behaviors. METHODS: A survey designed to assess attitudes and behaviors regarding naloxone prescribing practices was emailed to all prescribing providers at an urban academic emergency department. Descriptive and summary statistics were performed. RESULTS: The response rate was 29% (36/124). Nearly all respondents (94%) expressed openness to prescribing naloxone from the emergency department, but only 58% had actually done so. Most (92%) believed that patients would benefit from greater access to naloxone, however 31% also believed that opioid use would increase as access to naloxone increases. Time was the most frequently identified barrier (39%) to prescribing, followed by a perceived inability to properly educate patients on naloxone use (25%). CONCLUSIONS: In this study of emergency medicine providers, the majority of respondents were amendable to prescribing naloxone, yet almost half had not done so and some believed that doing so would increase opioid use. Barriers included time constraints and perceived self-reported knowledge deficits regarding naloxone education. More information is needed to gauge the impact of individual barriers to prescribing naloxone, but these findings may provide information that can be incorporated in provider education and potential clinical pathways designed to increase naloxone prescribing.

QTc Prolongation in Poison Center Exposures to CredibleMeds List of Substances with "Known Risk of Torsades de Pointes".

Many drugs carry some risk of QT interval prolongation, which can lead to life-threatening dysrhythmias including Torsades de Pointes (TdP). CredibleMeds.org identifies medications categorized as "Known Risk of TdP" but does not stratify risk in acute supratherapeutic ingestions. We sought to determine the proportion of cases exhibiting QTc prolongation and life-threatening dysrhythmias including ventricular tachycardia (VT)/ventricular fibrillation (VF), TdP, and asystole in patients exposed to these substances. Retrospective chart review of cases reported to our Regional Poison Center from 2014 to 2019 of exposures to one or more of the "Known Risk" substances was performed. Demographics, therapies, clinical effects, and medical outcome for each case were analyzed. There were 1125 exposures, of which 760 had a documented QTc interval. QTc ≥ 500 ms was reported in 138 (18.2%) of the 760 cases. The most common "Known Risk" substances were citalopram, escitalopram and cocaine. Although not in the "Known Risk" category, mirtazapine, amitriptyline, diphenhydramine, and trazodone had a statistically significant association with QTc > 500 ms. Life-threatening dysrhythmias occurred in 13 cases, with VT/VF in 6 of the 760 (0.8%) cases, and one case of TdP. Flecainide (OR 11.1, 95% CI 2.2-55.8) and methadone (OR 7.1, 95% CI 2.1-23.4) were associated with increased risk of all life-threatening dysrhythmias. Exposures to medications on the Credible Meds list of "Known Risk of TdP" QTc prolongation is common, but life-threatening dysrhythmias are rare. Mirtazapine, amitriptyline, diphenhydramine, and trazodone were associated with prolonged QTc. Flecainide and methadone had the highest associated risk of life-threatening dysrhythmias.

Analysis of Emergency Department Patient-Visit Volumes in an Academic Health System During a COVID-19 Pandemic Statewide 'Safer at Home' Order.

BACKGROUND: We describe patient-visit volumes, patient acuity, and demographics in our 4 academic health system emergency departments (ED) before, during, and after implementation of a COVID-19 pandemic safer-at-home order. METHODS: Data were collected from the electronic health record, including patient-visit volumes, chief complaint, Emergency Severity Index (ESI), and patient demographics. Descriptive statistics were performed. RESULTS: There was a 37% decrease in combined ED patient-visit volume during the safer-at-home order period (42% at the academic medical center). ED patient-visit volumes increased after the safer-at-home order concluded. During the safer-at-home order period, there was an increase in the proportion of ESI-2 visits and admission rates from EDs across the system. CONCLUSIONS: Significant differences in ED patient-visit volumes and patient acuity were associated with a safer-at-home order in our academic health system. These differences are similar to experiences of other hospital systems across the country.

Zolpidem misuse with other medications or alcohol frequently results in intensive care unit admission.

Zolpidem (trade name Ambien ®) is commonly prescribed. Case reports and popular media suggest potential dangers exist and may result in unanticipated complications. The primary aim was to determine how commonly zolpidem ingestion results in hospital evaluation and admission. The secondary aim of this study was to determine what patient and clinical characteristics are associated with complications from zolpidem use. A retrospective review of all cases involving zolpidem reported to the Illinois Poison Center between January 1, 2004 and December 31, 2005 was conducted. Data were prospectively entered into a structured clinical database in real time at the Illinois Poison Center. Demographic, co-ingestant, and outcome data for all zolpidem cases was abstracted into a research database and analyzed using descriptive, univariate and multivariate analyses. Six-hundred ninety-two cases met inclusion criteria. Mean age was 34.7 years. Four-hundred sixty three cases (67%) resulted in Emergency Department (ED) evaluation. Only 17% (81/463) of ED patients were discharged home: 44% (203/463) required Intensive Care Unit (ICU) admit, 17% (79/463) medical floor admit, 16% (72/463) psychiatry admit. Associated with ICU admission were co-ingestion of over-the-counter medicines (OR 3.33, 95% CI, 1.93 to 5.76), other prescribed psychotropics (antidepressants or mood stabilizers) (OR 3.11, 95% CI, 2.21 to 4.39), or ethanol (OR 2.12, 95% CI, 1.36 to 3.32). When zolpidem is ingested with other medications or ethanol, admission to the ICU was common in our series. Despite its reported safely, zolpidem overdose often requires ICU admission from the ED, which is associated with ingestion of other pharmaceutical products or alcohol.

Physician attitudes on buprenorphine induction in the emergency department: results from a multistate survey.

STUDY OBJECTIVE: Emergency Departments (ED) are rapidly becoming an important location for initiation of buprenorphine (EDBUP) for the treatment of opioid use disorder (OUD). Previous investigations of emergency medicine physicians' perceived barriers and attitudes toward EDBUP exclusively sampled from urban, academic-affiliated physicians. We administered a multistate survey to an institutionally and geographically diverse collection of emergency medicine physicians to better understand the professional opinions of EDBUP implementation across a variety of practice settings. METHODS: This cross-sectional survey study used an online survey instrument to convenience sample emergency medicine physicians. In order to sample from various practice environments, participants were identified from (1) statewide ACEP chapters and (2) Facebook groups exclusive to emergency medicine physicians. The survey explored physicians' attitudes of EDBUP adoption and the perceived barriers to doing so. RESULTS: 162 emergency medicine physicians completed the survey. 76% of respondents agreed that emergency medicine physicians should offer EDBUP in the treatment of OUD. When stratified by practice setting and X-waiver status, 96% of X-waivered physicians, 73% of academic physicians, 49% of non-academic physicians, and 34% of non-X-waivered physicians felt comfortable initiating EDBUP. Lack of access to outpatient MOUD referral was the most frequently cited barrier to EDBUP across all practice settings. CONCLUSIONS: An institutionally and geographically diverse group of emergency medicine physicians endorsed substantial support for EDBUP. Emergency medicine physicians practicing in different clinical environments endorsed similar barriers to EDBUP implementation.

Expert consensus guidelines for stocking of antidotes in hospitals that provide emergency care.

STUDY OBJECTIVE: We developed recommendations for antidote stocking at hospitals that provide emergency care. METHODS: An expert panel representing diverse perspectives (clinical pharmacology, clinical toxicology, critical care medicine, clinical pharmacy, emergency medicine, internal medicine, pediatrics, poison centers, pulmonary medicine, and hospital accreditation) was formed to create recommendations for antidote stocking. Using a standardized summary of the medical literature, the primary reviewer for each antidote proposed guidelines for antidote stocking to the full panel. The panel used a formal iterative process to reach their recommendation for the quantity of an antidote that should be stocked and the acceptable period for delivery of each antidote. RESULTS: The panel recommended consideration of 24 antidotes for stocking. The panel recommended that 12 of the antidotes be available for immediate administration on patient arrival. In most hospitals, this period requires that the antidote be stocked in the emergency department. Another 9 antidotes were recommended for availability within 1 hour of the decision to administer, allowing the antidote to be stocked in the hospital pharmacy if the hospital has a mechanism for prompt delivery of antidotes. The panel identified additional antidotes that should be stocked by the hospital but are not usually needed within the first hour of treatment. The panel recommended that each hospital perform a formal antidote hazard vulnerability assessment to determine the need for antidote stocking in that hospital. CONCLUSION: The antidote expert recommendations provide a tool to be used in creating practices for appropriate and adequate antidote stocking in hospitals that provide emergency care.

Lacosamide: a Study of Exposures Reported to US Poison Centers over a 9-Year Period.

BACKGROUND: Lacosamide (Vimpat®) is an anticonvulsant used to treat partial-onset seizures. Little is known about the characteristics and outcomes of patients exposed to lacosamide. OBJECTIVE: To characterize lacosamide exposures reported to US poison centers with regard to patient demographics, clinical effects, and outcomes. METHODS: This retrospective observational study queried the National Poison Data System (NPDS) for single substance lacosamide exposures from January 2008 to December 2016. Variables of interest included age, gender, medical outcome, management site, level of healthcare facility, reason for exposure, and clinical effects. RESULTS: Lacosamide exposures were identified in 1124 patients, ranging from ages 2 months to 99 years. Six hundred and twenty-two patients (55.3%) were female. Nine hundred and seventy-six patients (86.8%) had minimal or no toxic effects. Life-threatening exposures numbered 30 cases (2.7%). There was one death. Five hundred and forty-eight patients (48.8%) did not require healthcare management while 537 (47.7%) were either referred to or already at a hospital. Among those treated at a healthcare facility, 269 (50.1%) did not require admission. Thirty-three patients (6.1%) were admitted to a psychiatric facility, 68 (12.7%) to a non-critical care unit, and 93 (17.3%) to a critical care unit. Six hundred and thirty-two exposures (56.2%) were due to therapeutic error. Suicide attempts numbered 168 (14.9%). Neurologic, gastrointestinal, and cardiovascular symptoms were commonly encountered. CONCLUSION: Lacosamide exposures infrequently cause death or disability; however, a considerable proportion of the study population required intensive care. Exposed patients with symptoms require healthcare evaluation.

Impact of a chronic pain management pathway on opioid administration and prescribing in an Emergency Department.

CONTEXT: Prescription opioid abuse and misuse is a significant public health crisis. In 2012, an opioid prescribing pathway for patients with chronic pain presenting to the Emergency Department (ED) was implemented. The objective of this study is to determine the impact of the pathway for administration of opioids in the ED as well as the prescribing of opioids for home use after discharge. METHODS: Retrospective pre- and post-intervention time series study of consecutive patients presenting to the ED with acute and chronic pain complaints before and after implementation of the pathway. For the purposes of this study, we included patients with chronic abdominal or back pain - defined as pain present for greater than three months - and acute pain as acute long bone fracture. RESULTS: Before pathway implementation, there was no statistically significant difference in the mean morphine equivalent (MEQ) dose administered for chronic or acute pain patients. After pathway implementation, there was a decrease in IV/IM morphine administered to patients with chronic pain (p = .0200) but not to patients with acute pain (p = .0820). Overall, MEQs administered did not change in either group. In the acute pain group, no significant differences were found in the number of patients who received opioid prescriptions upon discharge (p = .7749). However, in the chronic pain group, the number of patients who received opioid prescriptions upon discharge decreased with statistical significance (p = .0017). CONCLUSIONS: After the implementation of a chronic pain management pathway in an ED, there is a decrease noted in opioids administered to patients with chronic pain both in the ED and prescriptions on discharge. In patients presenting with acute pain, there was no change in administration or prescription of opioids.

Domestic violence among male and female patients seeking emergency medical services.

Gender differences among a cohort of injured patients seeking emergency medical services were examined with respect to their experiences as perpetrators and/or victims of domestic violence. Contextual issues, including violence initiation, emotional and behavioral responses to partner-initiated violence, and injury frequency and severity were analyzed. Women reported male partner-initiated violence more frequently than men reported female partner-initiated violence. Behavioral responses to partner initiated violence varied. Women were more likely to report using force back and to involve law enforcement. Women were more likely to be injured in a domestic assault over their lifetime, within the last year, and at the time of recruitment. Comparison of injury severity revealed that women reported higher rates of injuries than men in all possible severity categories. Women also reported experiencing more fear than men during partner-initiated violence, as well as being subjected to larger numbers of dominating and controlling behaviors, and greater intimidation secondary to their partner's size. Understanding contextual differences in partner violence for women and men has significant implications for policy development, identification, treatment, and referral of patients identified as living in violent relationships.

Enlarged vomeronasal organ in a child: imaging findings.

The vomeronasal organ is a special sensory organ that exists in both animals and humans. It is located on the sides of nasal septum and although it involutes with age, occasionally it may be seen in humans. We present the imaging findings in a child with an enlarged nasal septum whose features we believe are compatible with a vomeronasal organ.

Characterization of adolescent prescription drug abuse and misuse using the Researched Abuse Diversion and Addiction-related Surveillance (RADARS(®)) System.

OBJECTIVE: To describe the characteristics and health effects of adolescent (age 13-19 years) prescription drug abuse and misuse using the Researched Abuse Diversion and Addiction-Related Surveillance (RADARS(®)) System. METHOD: Secondary analysis of data collected from RADARS System participating poison centers was performed. Data for all intentional exposures from 2007 through 2009 were used to describe adolescent prescription opioid (oxycodone, fentanyl, hydrocodone, hydromorphone, morphine, methadone, buprenorphine, and tramadol) and stimulant (methylphenidate and amphetamines) exposures. RESULTS: A total of 16,209 intentional adolescent exposures to prescription drugs were identified, 68% to opioids and 32% to stimulants. The mean age was 16.6 years (SD ± 1.7 years). Slightly more than half (52.4%) of drug mentions involved females. The five most frequently misused or abused drugs were hydrocodone (32%), amphetamines (18%), oxycodone (15%), methylphenidate (14%), and tramadol (11%). Of all exposures, 38% were classified as suspected suicidal. Of adolescents who intentionally exposed themselves to prescription drugs, 30% were treated in a health care facility, 2,792 of whom were admitted to the hospital, including 1,293 to the intensive care unit. A total of 17.2% of intentional exposures were associated with no effect, 38.9% minor effects, 23.3% moderate effects, 3.6% major effects, and 0.1% were associated with death. Oxycodone and methadone were associated with the most deaths. No deaths were associated with exposures to stimulants. CONCLUSIONS: Prescription drug misuse and abuse poses an important health problem and results in thousands of hospitalizations of adolescents per year. Further work is needed to develop focused interventions and educational programs to prevent prescription drug abuse and misuse by adolescents.

Severe lactic acidosis after an iatrogenic propylene glycol overdose.

Propylene glycol is a diluent found in many intravenous and oral drugs, including phenytoin, diazepam, and lorazepam. Propylene glycol is eliminated from the body by oxidation through alcohol dehydrogenase to form lactic acid. Under normal conditions, the body converts lactate to pyruvate and metabolizes pyruvate through the Krebs cycle. Lactic acidosis has occurred in patients, often those with renal dysfunction, who were receiving prolonged infusions of drugs that contain propylene glycol as a diluent. We describe a 50-year-old man who experienced severe lactic acidosis after receiving an accidental overdose of lorazepam, which contains propylene glycol. The patient was acutely intoxicated, with a serum ethanol concentration of 406 mg/dl. He had choked on a large piece of meat and subsequently experienced pulseless electrical activity with ventricular fibrillation cardiac arrest. He was brought to the emergency department; within 2 hours, he was admitted to the intensive care unit for initiation of the hypothermia protocol. The patient began to experience generalized tonic-clonic seizures 12 hours later, which resolved after several boluses of lorazepam. A lorazepam infusion was started; however, it was inadvertently administered at a rate of 2 mg/minute instead of the standard rate of 2 mg/hour. Ten hours later, the administration error was recognized and the infusion stopped. The patient's peak propylene glycol level was 659 mg/dl, pH 6.9, serum bicarbonate level 5 mEq/L, and lactate level 18.6 mmol/L. Fomepizole was started the next day and was continued until hospital day 3. Continuous renal replacement therapy was started and then replaced with continuous venovenous hemofiltration (CVVH) for the remainder of the hospital stay. The patient's acidosis resolved by day 3, when his propylene glycol level had decreased to 45 mg/dl. Fomepizole was discontinued, but the patient's prognosis was poor (anoxic brain injury); thus care was withdrawn and the patient died. Although the patient's outcome was death, his lactic acidosis was treated successfully with fomepizole and CVVH. Clinicians should be aware that an iatrogenic overdose of lorazepam may result in severe propylene glycol toxicity, which may be treated with fomepizole and CVVH.

A comparison of analgesic management for emergency department patients with sickle cell disease and renal colic.

OBJECTIVES: To determine whether there is a difference in time to initial analgesic for patients with acute pain from sickle cell disease (SCD) versus renal colic (RC) and to identify factors contributing to variance in time to analgesic. METHODS: A retrospective cohort study of the adult emergency department (ED) patients with acute pain from SCD and RC in an urban ED (final ED discharge ICD-9 diagnosis codes were included). A structured medical record review abstracted the demographics, arrival shift, triage level, initial pain score, triage time, and time of initial analgesic dose. Data were compared with Kaplan-Meier plots of time to initial analgesic for both RC and SCD with the log-rank test to test for differences by disease category. A multivariable Cox regression model estimated differences in time to initial analgesic by disease category while controlling for other possible confounders. RESULTS: Median time to initial analgesic was 80 minutes for patients with SCD (interquartile range, 48 to 145) versus 50 minutes for patients with RC (interquartile range: 30 to 96). Patients with SCD reported a higher pain score on arrival when compared with RC patients and were more frequently assigned a higher triage priority level (P=0.05). Covariates that contributed the most delays to the model were afternoon arrival [hazard ratio (HR): 0.35, P<0.01], low acuity triage level (HR: 0.42, P<0.01), SCD diagnosis (HR: 0.61, P<0.01), and inability to obtain intravenous access (HR: 0.71, P=0.01). DISCUSSION: ED patients with SCD experienced longer delays in the administration of the initial analgesic compared with RC patients, despite higher arrival pain scores and triage acuity levels.

A multicenter comparison of the safety of oral versus intravenous acetylcysteine for treatment of acetaminophen overdose.

UNLABELLED: Oral and intravenous (IV) N-acetylcysteine (NAC) are used for the treatment of acetaminophen poisoning. The objective of this multicenter study was to compare the safety of these two routes of administration. METHODS: We conducted a multicenter chart review of all patients treated with NAC for acetaminophen poisoning. The primary safety outcome was the percentage of patients with NAC-related adverse events. RESULTS: A total of 503 subjects were included in the safety analysis (306 IV-only, 145 oral-only, and 52 both routes). There were no serious adverse events related to NAC for either route. Nausea and vomiting were the most common related adverse events and were more common with oral treatment (23 vs. 9%). Anaphylactoid reactions were more common with IV administration (6 vs. 2%). CONCLUSIONS: IV and oral NAC are generally mild adverse drug reactions.