The Journal of emergency medicine
June 1, 2011
Rais Vohra, Andrew Seefeld, F Lee Cantrell et al.
45 citations
Salvia divinorum, a hallucinogenic herb marketed as a legal alternative to other drugs, has become popular among teenagers and young adults. A retrospective review of 37 exposures to S. divinorum reported to a poison control system over 10 years found that intentional use caused neurologic, cardiovascular, and gastrointestinal effects. Use with other substances was associated with a high rate of complications and psychomotor disturbances. The findings help characterize the clinical toxicity of this emerging substance, but more research is needed.
The Journal of emergency medicine
October 1, 2019
James Grogan, Roy Gerona, Jerry W Snow et al.
16 citations
Ibogaine, a psychoactive indole alkaloid used experimentally for opioid addiction and available via Internet suppliers, can cause life-threatening cardiac effects. A 34-year-old woman with heroin and cocaine use disorder ingested 2 g of ibogaine powder, experienced hallucinations and seizure-like episodes, and developed QTc prolongation and torsade de pointes. Qualitative analysis confirmed ibogaine in the ingested material. As more people with opioid use disorder seek ibogaine, emergency physicians need to recognize and treat this dangerous exposure.
The Journal of emergency medicine
January 6, 2025
Jake Hoyne, Jonathan Edlow
7 citations
Endotracheal intubation in patients with acute brain injury or ischemia carries a risk of secondary brain injury if not performed with caution. Before intubation, avoiding extremes in blood pressure, preoxygenating, and managing elevated intracranial pressure are critical. During intubation, using a hemodynamically neutral induction agent like ketamine or etomidate minimizes hypotension; ketamine, once avoided, is now considered acceptable as it does not affect cerebral perfusion pressure. Video laryngoscopy is recommended. After intubation, ventilator settings should target eucapnia, and adequate sedation helps manage intracranial pressure. EEG monitoring can detect non-convulsive status epilepticus. These evidence-based practices aim to minimize secondary brain injury and improve outcomes.