January 7, 2021

Background/Introduction: Emergency department visits related to cannabis use appear to be increasing nationally secondary to continued trends of legalization, decriminalization, or less restrictive medical cannabis use laws in many states. The number of individuals with daily cannabis use in the United States increased from 5.1 million in 2005 to 8.1 million in 2013 (Bollom 2018). With an increase in the accessibility and consumption of cannabis, there has also been an increase in the utilization of emergency departments for potential adverse effects of cannabis use, particularly gastrointestinal adverse effects. For example, in Colorado, the emergency department visits for cyclic vomiting nearly doubled after liberalization of medical marijuana (Kim 2015). Studies attempting to look at nationwide sampling have noted that the number of persistent vomiting related hospitalization related to cannabis use had a significantly increased trend, with a 286% increase over a 5-year period (Patel 2019). This has led to a renewed interest in the understanding of cannabis hyperemesis syndrome, first well-described in 2004, and recently defined by the Rome IV criteria (Allen 2004). The effective management of cannabis hyperemesis syndrome is still being elucidated as commonly used antiemetics are often ineffective for acute exacerbations. The role of haloperidol as an off-label treatment is being explored but anecdotal evidence suggests it may be an effective adjunct in the treatment of cannabis hyperemesis syndrome.

November 9, 2020

Background/Introduction: The use of Sodium Bicarbonate (SB) in cardiac arrest has had a complicated history with strong and varied opinions on its effectiveness. SB was recommended in earlier ACLS guidelines, mostly stemming from the notion that severe metabolic acidosis due to hypoxia and hypoperfusion during cardiac arrest led to impaired myocardial contractility, decreased effectiveness of vasopressors, and increased risk of dysrhythmias. Subsequent data called into question the benefits of SB in cardiac arrest and highlighted potential harms such as hypernatremia, hyperosmolarity, metabolic alkalosis, as well as reduction in ionized calcium, vascular resistance, and extracellular fluid volume expansion. This led to the 2010 ACLS guidelines stating that routine use of SB is not recommended (Class IIIB) and that it may be considered in special circumstances (preexisting metabolic acidosis, Hyperkalemia, or TCA overdose). Despite this, the use of SB during cardiac arrest is still common in emergency departments with varying opinions on its effectiveness. In fact, recently published data from the National Emergency Medicine Services Information System (NEMSIS) noted that besides epinephrine and normal saline, sodium bicarbonate was the third most commonly used medication in out of hospital cardiac arrest (Chan 2020). This study aimed to consolidate the state of evidence behind the use of SB in cardiac arrest.

November 6, 2020

Babesiosis

Epidemiology Incidence:
  • Overall annual incidence rose from 0.6 to 0.9 cases per 100,000 in the United States between 2012 and 2015 (Gray 2019)
  • Annual incidence is highest in those between 60-69 years of age (Gray 2019)
Age:
  • Median age is 63 years of age with greater than 89% of cases reported in Caucasian patients (Gray 2019 2010)
Gender:
  • Male to female predominance (Gray 2019)

November 5, 2020

Rocky Mountain Spotted Fever (RMSF)

Epidemiology Incidence:
  • Overall annual incidence rose from 1.7 to 7 cases per million in the United States between 2000 and 2007 (Openshaw 2010)
  • Annual incidence is highest in children aged 5-9 years of age (Amsden 2005)
Age:
  • Median age is 42 years of age with greater than 87% of cases reported in Caucasian patients (Openshaw 2010)
Gender:
  • Slight male to female predominance (Openshaw 2010)

November 4, 2020

Ehrlichiosis

Epidemiology Incidence:
  • Overall annual incidence noted to be 3.2 cases per million in the United States between 2008 and 2012 (Biggs 2016)
  • Highest incidence occurs in those 60-69 years of age (Biggs 2016)
Age:
  • Median age is 55 years of age with 64% of cases reported in Caucasian patients (Heitman 2016)
Gender:
  • Slight male to female predominance (Heitman 2016)
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