Acetaminophen and salicylate are among the most widely used nonprescription analgesics and are common causes of toxic medication overdose. Diagnostic and management approaches differ depending on whether toxicity results from a single acute ingestion or chronic supratherapeutic use. Although acetaminophen and salicylate toxicity are well studied, controversies remain regarding management. This review presents a systematic approach to the emergency department management of patients with acetaminophen or salicylate toxicity, including discussion of the tools used to assess severity, guide treatment decisions, and determine prognosis.
Intracranial hemorrhage following intravenous thrombolytic therapy most commonly occurs within 12 hours of administration. Because many patients remain in the emergency department during this period, a structured, time-sensitive approach to recognition and management is critical. This review summarizes current recommendations for the diagnostic workup, use of reversal agents, and escalation of care for postthrombolysis intracranial hemorrhage, with particular attention to guidelines addressing stroke and neurocritical care management. Contraindications to intravenous thrombolysis and risk factors for postthrombolysis intracranial hemorrhage are also discussed.
Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are rare but potentially fatal mucocutaneous emergencies that exist on a spectrum and are most commonly caused by a medication reaction. Although data guiding diagnosis and management remain limited, early recognition, prompt identification and discontinuation of the causative agent, symptomatic management, and multidisciplinary involvement are essential to improving patient outcomes. Validated prognostic tools can further guide management decisions. This review provides an evidence-based approach to the recognition and management of SJS/TEN in the emergency department.
Heat-related illness encompasses a spectrum of conditions ranging from heat cramps and heat exhaustion to life-threatening heat stroke, all resulting from impaired thermoregulation under excessive environmental heat load. The incidence and severity of heat-related illnesses are increasing, underscoring the need for evidence-based emergency management strategies. Accurate diagnosis requires differentiating heat-related illness from conditions that may mimic hyperthermia. Timely recognition and rapid cooling are the cornerstones of management. This review summarizes current evidence on the diagnosis, treatment, and disposition of heat-related illness in the emergency department, with an emphasis on distinguishing heat stroke from conditions with overlapping clinical presentations and on optimizing cooling interventions.
