Abstract:
:In 2013 and 2014, more than 700 deaths were attributed to fentanyl and fentanyl analogues in the United States. Of recent concern is the cluster of unintentional fentanyl overdoses because of tablets thought to be "Norco" purchased on the street in Northern California. U-47700 (trans-3,4-dichloro-N-[2-(dimethyl-amino)cyclohexyl]-N-methylbenz-amide) is a nonfentanyl-based synthetic opioid with 7.5 times the binding affinity of morphine to μ-opioid. We report a case of fentanyl and U-47700 intoxication from what was thought to be illicitly purchased Norco. A 41-year-old woman presented to the emergency department (ED) for altered mental status shortly after ingesting 3 beige Norco pills bearing a Watson imprint. She had pinpoint pupils and respiratory depression, which reversed after 0.4 mg naloxone administration intravenously. She had complete recovery and was discharged from the ED after a 4-hour observation period. Serum testing with liquid chromatography-quadrupole time-of-flight mass spectrometry (LC 1260 QTOF/MS 6550; Agilent, Santa Clara, CA) confirmed the presence of the medications the patient reported receiving, and additionally fentanyl (15.2 ng/mL) and U-47700 (7.6 ng/mL). In this case report, street Norco purchased in Central California resulted in altered mental status requiring naloxone reversal because of fentanyl and the novel synthetic opioid U-47700. Because these compounds are not detected by routine urine drug testing and physical examination findings are similar to those of a traditional opioid toxidrome, emergency providers should use the patient's history and other circumstantial details to aid in diagnosis. In cases with suspicion of opioid or opioid analogue cause, we recommend that emergency providers contact their local poison control center, medical toxicologist, or public health department to aid in the investigation.
journal_name
Ann Emerg Medjournal_title
Annals of emergency medicineauthors
Armenian P,Olson A,Anaya A,Kurtz A,Ruegner R,Gerona RRdoi
10.1016/j.annemergmed.2016.06.014subject
Has Abstractpub_date
2017-01-01 00:00:00pages
87-90issue
1eissn
0196-0644issn
1097-6760pii
S0196-0644(16)30292-Xjournal_volume
69pub_type
杂志文章abstract::Sodium metabisulfite (MBS) is a commonly used food and drug preservative. We report the case of a 32-year-old man with a documented history of allergy to MBS who developed an anaphylactic reaction after ingestion of MBS-treated foods. The patient had a prolonged clinical course requiring two emergency department visit...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/s0196-0644(86)80492-9
更新日期:1986-01-01 00:00:00
abstract:STUDY OBJECTIVE:To examine the spectrum of electrical injuries and develop guidelines for management. DESIGN:Retrospective review of charts compiled during a 6-year period (1988 through 1993). SETTING:Pediatric emergency department. PARTICIPANTS:Seventy-eight patients seen for electrical injuries. RESULTS:Fifty-fou...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/s0196-0644(95)70012-9
更新日期:1995-11-01 00:00:00
abstract:STUDY OBJECTIVE:To determine whether emergency medical services (EMS) run reports adequately document vehicle damage when compared with vehicle photographs by using a traffic accident scoring system. DESIGN:A prospective study consisting of three phases: photographing motor vehicle collisions and collecting their resp...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/s0196-0644(05)81842-6
更新日期:1993-04-01 00:00:00
abstract:STUDY OBJECTIVE:To determine whether water or 0.9% saline should be used as diluent for endobronchial drug administration. PARTICIPANTS:Twelve adult patients. INTERVENTIONS:Patients were endobronchially administered 2 mg/kg lidocaine as marker substance in either 10 mL 0.9% saline or 10 mL distilled water during gene...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/s0196-0644(05)82293-0
更新日期:1990-11-01 00:00:00
abstract:STUDY OBJECTIVE:To determine the accuracy of four methods of endotracheal tube size selection in the pediatric population. STUDY DESIGN:Prospective, blinded comparison. SETTING:The Children's Hospital of Philadelphia. PARTICIPANTS:Two hundred thirty-seven children aged 1 month to 9 years old undergoing elective surg...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/s0196-0644(05)81937-7
更新日期:1993-03-01 00:00:00
abstract:STUDY OBJECTIVE:To gather preliminary data on the safety and efficacy of IV magnesium in a rat model of hydrofluoric acid burns. MODEL:Forty-seven anesthetized male rats (200 to 300 g) received a standardized burn with 52% hydrofluoric acid. INTERVENTIONS:Animals were anesthetized with 30 to 50 mg/kg ketamine IM and ...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/s0196-0644(94)70064-8
更新日期:1994-03-01 00:00:00
abstract:STUDY OBJECTIVES:To confirm the ability of the esophageal detector device (EDD) to indicate positioning of endotracheal tubes (ETTs) in patients intubated under emergency conditions and to compare the performance of the EDD with that of end-tidal carbon dioxide (ETCO2). METHODS:This single-subject study comprising a p...
journal_title:Annals of emergency medicine
pub_type: 临床试验,杂志文章
doi:10.1016/s0196-0644(96)70162-2
更新日期:1996-05-01 00:00:00
abstract::Maprotiline, a new tetracyclic antidepressant, has a pattern of toxicity that is different from that of tricyclics. Maprotiline overdosage appears more likely to cause seizures but less likely to cause the peripheral autonomic and cardiac manifestations seen with tricyclics. Two cases of maprotiline overdose resulting...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/s0196-0644(84)80016-5
更新日期:1984-06-01 00:00:00
abstract::[Salomon B: Emergency department fugue. Ann Emerg Med March 1998;31:412-413]. ...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/S0196-0644(98)70358-0
更新日期:1998-03-01 00:00:00
abstract:STUDY OBJECTIVE:We sought to examine the outcome of a subgroup of patients with extreme carbon monoxide (CO) poisoning, specifically those discovered in cardiac arrest, resuscitated, and subsequently treated with hyperbaric oxygen (HBO(2)). Opinions of hyperbaric medicine physicians regarding the treatment of such pati...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1067/mem.2001.115532
更新日期:2001-07-01 00:00:00
abstract::The last 3 to 5 years have witnessed a tremendous change in direction for the academic health center. The major trends in this regard are increased importance of managed care, cost consciousness, development of a clinical system, pressure to downsize graduate medical education, and increased competition. ...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/s0196-0644(97)70045-3
更新日期:1997-12-01 00:00:00
abstract:STUDY OBJECTIVE:To assess the ability of parents to estimate their children's weight. METHODS:We assembled a convenience sample of children, newborn to 5 years, who presented to the ED of a tertiary care hospital. Each child's mother or father was asked to estimate the child's weight as accurately as possible. The tri...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/s0196-0644(97)70137-9
更新日期:1997-08-01 00:00:00
abstract::Reported is a case of a 34-year-old man, previously in good health, who underwent chiropractic manipulation of the cervical spine for treatment of a recent whiplash injury. Immediately following manipulation, the patient became unresponsive and was found to have sustained a brain stem infarction resulting in the "Lock...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/s0196-0644(83)80217-0
更新日期:1983-10-01 00:00:00
abstract:STUDY OBJECTIVE:We measure the rate of emergency department (ED) specimen processing error reduction after implementation of an electronic physician order entry system paired with a bar-coded specimen labeling process. METHODS:A cohort pre- and postintervention study was conducted in the ED during a 61-month period en...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/j.annemergmed.2010.05.028
更新日期:2010-12-01 00:00:00
abstract::Two case reports of patients with anion gap metabolic lactic acidosis and hypoglycemia are presented. Both patients subsequently died of acute liver failure secondary to acetaminophen hepatotoxicity. The development of type B lactic acidosis with hypoglycemia might have been caused by a deficit in gluconeogenesis seco...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/s0196-0644(84)80674-5
更新日期:1984-10-01 00:00:00
abstract:STUDY OBJECTIVE:The foraging of wild mushrooms can be complicated by toxicity from several mushroom types. Amatoxin, a peptide contained in several mushroom species, accounts for the majority of severe mushroom poisonings by binding to RNA polymerase II irreversibly, leading to severe hepatonecrosis. There is no effect...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/j.annemergmed.2006.12.015
更新日期:2007-09-01 00:00:00
abstract::Increasing numbers of patients with diagnosed HIV infection are presenting to inner-city emergency departments. Unfortunately, there is little information available on the characteristics and emergency clinical problems of HIV-infected patients to guide physicians in patient care and strategies for resource use. Preli...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/s0196-0644(05)82555-7
更新日期:1990-09-01 00:00:00
abstract:STUDY OBJECTIVE:We sought to characterize the clinical manifestations, outcome, and etiology of inadvertent ketamine overdose in the emergency department. METHODS:We investigated cases of inadvertent ketamine overdose in children seen in the ED solicited through electronic mail subscription lists or reported to the In...
journal_title:Annals of emergency medicine
pub_type: 杂志文章,多中心研究
doi:10.1016/s0196-0644(99)80051-1
更新日期:1999-10-01 00:00:00
abstract:STUDY OBJECTIVE:We sought to determine whether working 5 serial night shifts in the emergency department results in a decline in physician performance as measured with an intelligence test. METHODS:This study compared the cognitive functioning of emergency physicians who worked the day shift (7 AM to 5 pm) with those ...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1067/mem.2001.116024
更新日期:2001-08-01 00:00:00
abstract::There are currently 20 autonomous departments of emergency medicine in United States medical schools. EDs seeking autonomous status should institute a faculty development program to channel faculty energy into worthwhile research projects; establish protected time for clinical faculty to increase research productivity...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/s0196-0644(05)82395-9
更新日期:1991-06-01 00:00:00
abstract:STUDY OBJECTIVE:To develop clinical rules for the safe and effective use of flumazenil in suspected benzodiazepine overdose. METHODS:We assembled a retrospective series of 35 consecutive comatose patients admitted between October 1992 and July 1993 to a toxicologic ICU with the presumptive diagnosis of drug overdose. ...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/s0196-0644(96)70191-9
更新日期:1996-06-01 00:00:00
abstract:STUDY OBJECTIVE:Radiology-performed transabdominal pelvic ultrasound, used to evaluate female patients with suspected pelvic pathology in the pediatric emergency department (ED), is often delayed by the need to fill the bladder. We seek to determine whether point-of-care ultrasound assessment of bladder fullness can pr...
journal_title:Annals of emergency medicine
pub_type: 杂志文章,随机对照试验
doi:10.1016/j.annemergmed.2018.04.010
更新日期:2018-11-01 00:00:00
abstract:STUDY OBJECTIVE:Physicians often prescribe antibiotics to patients even when there is no clear indication for their use. Previous studies examining antibiotic use in acute bronchitis and upper respiratory infections have been conducted in primary care settings. We evaluate the factors that physicians in the emergency d...
journal_title:Annals of emergency medicine
pub_type: 杂志文章,多中心研究
doi:10.1016/j.annemergmed.2007.03.026
更新日期:2007-09-01 00:00:00
abstract::Autoerythrocyte sensitization syndrome is characterized by sudden and spontaneous painful bruising and swelling occurring in young female patients with psychiatric disorders. This syndrome may present with such severe swelling of involved areas that aspiration or excision may be needed to relieve pressure. The present...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/s0196-0644(89)80019-8
更新日期:1989-07-01 00:00:00
abstract::We report the cases of two children with acute plastic fractures of the long bones following trauma. Bowing deformity was evident clinically and radiographically in both cases. The unique radiologic features consisted of absence of fracture lines and of periosteal new bone formation during the healing phase. The mecha...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/s0196-0644(86)80997-0
更新日期:1986-05-01 00:00:00
abstract::A patient with primary axillary vein thrombosis was treated successfully in the emergency department with a single IV bolus of anistrepalase followed by continuous IV heparin. The patient's symptoms resolved quickly, and a repeat venogram 16 hours later showed near-complete resolution of the venous obstruction. We dis...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/s0196-0644(05)81863-3
更新日期:1993-04-01 00:00:00
abstract:STUDY OBJECTIVE:To identify the arterial and mixed venous blood gas changes caused by different ventilatory strategies during resuscitation from ventricular fibrillation in a pig model of closed-chest cardiac compression. METHODS:A prospective randomized animal study was performed using 27 domestic pigs (body weight, ...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/s0196-0644(98)70203-3
更新日期:1998-05-01 00:00:00
abstract:STUDY OBJECTIVE:We identify, describe, and categorize vulnerabilities in emergency department (ED) to internal medicine patient transfers. METHODS:We surveyed all emergency medicine house staff, emergency physician assistants, internal medicine house staff and hospitalists at an urban, academic medical center. Respond...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/j.annemergmed.2008.05.007
更新日期:2009-06-01 00:00:00
abstract::We reviewed the patterns of injuries sustained by 12 consecutive fallers and jumpers in whom primary impact was onto the feet. The fall heights ranged from 20 to 100 ft. The 12 patients sustained 49 significant injuries. Skeletal injuries were most frequent and included 15 lower extremity fractures, four pelvic fractu...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/s0196-0644(89)80107-6
更新日期:1989-02-01 00:00:00
abstract:STUDY OBJECTIVE:Previous studies have demonstrated that a sex disparity exists in the editorial boards of select specialties. However, there are limited data with respect to emergency medicine. We seek to determine the sex distribution of editors in chief and editorial board members among emergency medicine journals. ...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/j.annemergmed.2020.03.027
更新日期:2021-01-01 00:00:00