Browsing by Author "Purpura, Andrea"

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    Articles You May Have Missed
    (Springer Verlag, 2018-12) Nanagas, Kristine; Avera, Robert; Purpura, Andrea; Murphy, Jillian; Kao, Louise; Emergency Medicine, School of Medicine
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    “Ghost tablet” husks excreted in feces in large bupropion XL overdose
    (Taylor & Francis, 2018) Overberg, Adam; Purpura, Andrea; Nanagas, Kristine; Emergency Medicine, School of Medicine
    Background: Extended-release medications are widely prescribed across the spectrum of medical specialties; however, there is heterogeneity in how they are formulated. Commonly, they consist of an insoluble matrix or shell from which drug elutes, which may then be observed by patients when excreted in feces. We describe the case of a patient who ingested a large amount of extended-release bupropion tablets and subsequently passed a large number of these so-called “ghost tablets” in his stool. Case Details: A 19-year-old male presented in status epilepticus following intentional overdose of an unknown substance. He had prolonged QRS and QT intervals on ECG, hypotension requiring vasopressors, and tachycardia, and progressed to cardiac arrest and respiratory failure. On hospital day 4, he passed several large bowel movements containing apparent tablets. Serum bupropion and hydroxybupropion levels performed on serum taken at time of admission were 1800 ng/mL and 4200 ng/mL, respectively. Case Discussion: “Ghost tablets,” the insoluble remnant of some extended-release dosage forms, have been previously reported to appear in patients' stool in the course of therapeutic dosing. We present the case of a considerable quantity of these ghost tablets recovered from stool following a large bupropion XL overdose. Conclusion: Healthcare providers should be aware of the potential for this phenomenon to occur in poisoned patients. It should be documented as physical evidence of overdose in addition to clinical evidence.
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    Incidence and risk factors for carbon monoxide poisoning in an emergency department in Nepal
    (Taylor & Francis, 2022) Acharya, Samita Pant; Purpura, Andrea; Kao, Louise; House, Darlene R.; Emergency Medicine, School of Medicine
    Incidence of carbon monoxide (CO) poisoning in Nepal has not been studied. The objective of this study was to evaluate baseline carboxyhemoglobin (COHb) concentrations, population risk factors, and incidence of CO poisoning at a single hospital in Nepal. This was a prospective, observational study of patients presenting to Patan Hospital Emergency Department from April 2019 to March 2020. Demographics, risk factors for CO poisoning, symptoms, and clinical pretest probability of CO poisoning was documented. COHb concentration was obtained using a noninvasive co-oximeter. Significant CO exposure was defined as COHb concentration > 10%. CO poisoning was defined as COHb > 10% coupled with symptoms. Of 1,040 patients, 745 patients had a recordable COHb concentration. Median age was 40 years (IQR 33) with 407 (55%) females. Average COHb was 7.2%. Warm months were associated with higher COHb concentrations (8.1% vs 6.0%, p < 0.05). Firewood use had higher COHb concentrations compared to gas heating (8.6% vs 7.0%, p < 0.05). Overall, 228 (31%) patients had a COHb concentration > 10% indicating significant CO exposure. Sixteen patients had CO poisoning. We found a significant baseline incidence of COHb > 10% (31%) in patients presenting to a hospital in Nepal. Risk factors for higher baseline COHb concentrations included warm months and cooking with firewood.
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    Wellness: Combating Burnout and Its Consequences in Emergency Medicine
    (eScholarship Publishing, University of California, 2020-04-13) Stehman, Christine R.; Clark, Ryan L.; Purpura, Andrea; Kellogg, Adam R.; Emergency Medicine, School of Medicine
    Medicine recognizes burnout as a threat to quality patient care and physician quality of life. This issue exists throughout medicine but is notably prevalent in emergency medicine (EM). Because the concept of "wellness" lacks a clear definition, attempts at ameliorating burnout that focus on achieving wellness make success difficult to achieve and measure. Recent work within the wellness literature suggests that the end goal should be to achieve a culture of wellness by addressing all aspects of the physician's environment. A review of the available literature on burnout and wellness interventions in all medical specialties reveals that interventions focusing on individual physicians have varying levels of success. Efforts to compare these interventions are hampered by a lack of consistent endpoints. Studies with consistent endpoints do not demonstrate clear benefits of achieving them because improving scores on various scales may not equate to improvement in quality of care or physician quality of life. Successful interventions have uncertain, long-term effects. Outside of EM, the most successful interventions focus on changes to systems rather than to individual physicians. Within EM, the number of well-structured interventions that have been studied is limited. Future work to achieve the desired culture of wellness within EM requires establishment of a consistent endpoint that serves as a surrogate for clinical significance, addressing contributors to burnout at all levels, and integrating successful interventions into the fabric of EM.