Background:Substance abuse drives considerable emergency department (ED) demand and remains a major public-health issue. Although low educational attainment and tattoos are linked to high-risk behaviors, their relevance to drug-positive ED visits in Taiwan is unknown. Self-reported drug histories are also unreliable, with many patients denying use despite positive toxicology. We therefore examined these sociocultural markers in confirmed drug-positive cases to assess their value for ED risk stratification. Methods:This single-center descriptive cohort of ED patients with urine-confirmed illicit drug positivity summarized demographic/social characteristics, toxicology findings, and clinical presentations, with prespecified within-cohort contrasts (Fisher's exact and Mann-Whitney U; two-sided α = 0.05) across traffic injury, self-harm, and other presentations; no drug-negative control group was enrolled. Results:The cohort was predominantly male (83.3%) with a median age of 39 years (range, 17-74). Lower educational attainment (≤ upper secondary [senior/vocational high school; ISCED 0-3]) was observed in 40/54 (74.1%; 95% CI, 61.1-83.9), and visible tattoos in 32/54 (59.3%; 95% CI, 46.0-71.3) among drug-positive ED patients. Overall, 92.6% (95% CI, 82.4-97.1) of toxicology-confirmed drug-positive patients denied recent drug use, indicating approximately 13-fold under-detection by history alone. Methamphetamine was the leading substance (42.6%), and 85.0% had ≥ 2 psychoactive substances detected. These estimates are descriptive of the drug-positive cohort; no drug-negative comparator was enrolled. Conclusion:In this mixed urban-rural ED cohort with toxicology-confirmed illicit drug use, lower educational attainment and tattoo presence were commonly observed. Because the study lacked a drug-negative control group, these findings should be interpreted as descriptive rather than evidence of association. The very high prevalence of under-reporting indicates that history alone has limited sensitivity for detecting recent drug use and supports a low threshold for comprehensive toxicology testing, particularly in high-risk presentations and injured drivers. Methamphetamine predominance, frequent polysubstance exposure, and approximately one-in-five drug-positive presentations following traffic injuries highlight the need for clinical vigilance. These descriptive patterns warrant evaluation in multicenter prospective studies with quantitative toxicology capable of assessing impairment and causal relationships.
Acute flaccid paralysis (AFP) in adults is a clinical emergency with multiple causes, including hypokalemic periodic paralysis (hypoPP), Guillain-Barré syndrome (GBS), myasthenia gravis (MG), and botulinum neurotoxin (BoNT) poisoning. Herein, we present the case of a 64-year-old Asian man who ingested an unidentified fish. Within 30 minutes of ingestion, he developed flaccid paralysis along with gastrointestinal symptoms and perioral tingling. After 3 hours, his condition deteriorated to worsening respiratory distress and unconsciousness, requiring mechanical ventilation for one week. Blood and urine samples tested positive for 11-norTTX-6-ol, a tetrodotoxin (TTX) analog. Cytochrome b (Cytb) gene analysis of the remaining consumed fish revealed that the fish was Lagocephalus lunaris. Although TTX poisoning is rare, some countries have relatively high rates due to regional factors. When immediate laboratory confirmation is not possible, analysis of patient clinical history is crucial for diagnosis. Because this condition progresses rapidly, prompt stabilization of vital signs by clinicians increases the likelihood of survival and reduces the risk of death.
Background:Sympathetic crashing acute pulmonary edema (SCAPE) is a severe manifestation of acute heart failure, characterized by sudden pulmonary edema due to elevated sympathetic activity. Objective:This study aimed to describe the clinical profile, management, and short-term outcomes of patients with SCAPE presenting to a tertiary care hospital in North India. Methods:This prospective observational study described the clinical profile of patients with SCAPE who were managed with high-dose nitroglycerin (NTG). Results:Sixty-two patients with a mean age of 49.4 years were enrolled, and 90.3% had one or more comorbidities. All patients exhibited signs of sympathetic excess and pulmonary edema on point-of-care ultrasound (POCUS). The treatment protocol included high-dose NTG and non-invasive ventilation (NIV). Male sex, chronic kidney disease, longer symptom duration, plethoric inferior vena cava on POCUS, higher initial lactate, and the need for hemodialysis were identified as predictors of poor outcomes in the univariate analysis. Conclusions:This study highlights that a protocol-based approach using high-dose NTG and NIV in managing SCAPE patients shows a favorable outcome, resulting in low rates of mechanical ventilation and mortality despite high comorbidity burden and ICU admission rates.
Regular alternation of wide and narrow QRS complexes is a rare electrocardiographic finding. This report describes a case of sinus tachycardia with a 2:1 atrioventricular (A/V) conduction ratio, showing alternating narrow QRS complexes and right bundle branch block-patterned beats.
