Emergency Medicine

Children with Certain Disabilities at Greater Risk of Abuse

A new study shows that children with intellectual disabilities and mental/behavioral problems are at greater risk of maltreatment than those with autism, Down syndrome or birth defects, but support for all are needed

Traffic Deaths Reach 50-Year High: Opioids and Cannabis Are Adding to the Risk

  • Deaths due to traffic collisions rose in 2015 by 7.7%—the largest increase in 1966.
  • Opioid-related overdose deaths are at epidemic levels.
  • Cannabis use is legal in 25 states.
  • The cost of these collisions and deaths is estimated at nearly $38 billion.
  • Are these phenomena related?

Selfie-Related Deaths Continue to Rise Worldwide

  • The primary cause of death during self-photography was falling.
  • Wikipedia reports nearly 60 self-photography-related deaths since 2014.
  • Physicians can remind patients how profoundly distracting and dangerous smartphones can be.
  • Remind patients to first take full view of their surroundings, then stop and pay full attention to the phone, and then put it away; They are much safer doing just one thing at a time.

Pregabalin is Safe, Cost-Effective, and Clinically Effective for Treatment of Fibromyalgia

  • Fibromyalgia etiology is complex and multifaceted.
  • Syndrome affects millions of patients worldwide.
  • Fibromyalgia has significant negative personal, interpersonal, professional, and socioeconomic repercussions.
  • While fibromyalgia is frequently recalcitrant, pregabalin has been found to be an anchor therapy for the syndrome.
  • The syndrome afflicts between 6.5 million and more than 13 million Americans.
  • Pharmacoeconomic studies have revealed that pregabalin is cost-effective.

First Dagabitran Reversal Agent Approved

  • Dabigatran anti-coagulation can now be reversed.
  • FDA approves idarucizumab for reversal of dabigatran anti-coagulation.
  • Normal coagulation is established “in minutes.”
  • Preliminary data show idarucizumab to be safe and effective for reversal of dabigatran anti-coagulation.
  • Both efficacy and safety trials are sponsored by the manufacturer and published in top-tier journals.

Heroin-Fentanyl Combo Creates Street-Drug Emergency

  • Dealers are manufacturing fentanyl in order to mix it with heroin.
  • Widespread combining and selling of illicit fentanyl with street heroin.
  • Combination produces profound euphoria and powerful addiction.
  • Combination is significantly more lethal than either drug alone.

Naloxone Kits Stop Opioid Deaths, Cost ~$70

  • At around $70 per kit, this may be the most cost-effective life-saving intervention available to physicians.
  • The opioid epidemic is arguably the most significant current public health emergency in the U.S.
  • Depending on geography, the cost of an overdose survival is ~$10,000.
  • The average cost of an overdose-related death at the MetroHealth System in Cleveland, Ohio, is approximately $3000.
  • Naloxone kit distribution programs can be run at a cost of <$1000/life saved.

Wake Up Stroke: A Brief Literature Review


  • About 25% to 30% of ischemic strokes occur during sleep.
  • Tissue-plasminogen activator is the only specific stroke treatment proven effective in large randomized trials.
  • Without knowledge of exact time of symptom onset, this large group of patients is excluded from treatment with tissue-plasminogen activator.
  • Clinical and imaging studies suggest that many wake-up strokes occur close to awakening and these patients might be within the approved time-window for thrombolysis upon arrival at the emergency department.

Improving Care of Wake-Up Stroke Patients

  • About 25% to 30% of ischemic strokes occur during sleep.
  • Tissue-plasminogen activator is the only specific stroke treatment proven effective in large randomized trials.
  • Without knowledge of exact time of symptom onset, this large group of patients is excluded from treatment with tissue-plasminogen activator.
  • Clinical and imaging studies suggest that many wake-up strokes occur close to awakening and these patients might be within the approved time-window for thrombolysis upon arrival at the ED.