The consumption of shaojiu or distilled liquor played a significant role in Qing legal culture and contributed to a rise in alcohol-related crimes. Qing officials’ attitudes towards intoxication not only influenced their judgments on many cases, but also reflected important trends of popular beliefs, notions, and practices that constituted shared knowledge and feelings between ordinary people and judges. This paper examines the transformation of Qing judicial practices and concerns regarding alcohol intoxication and crimes, arguing that specific cultural value and ideas that underpinned the public configuration of drinking behaviour during the Qing period contributed to a social pathology around intoxication. Due to the lack of a consistent interpretation of the effects of alcohol on the mind, early Qing officials tended to be lenient towards intoxicated offenders. However, mid-Qing law-makers and rulers recognized the serious administrative concerns associated with heavy drinking and began to conceptualize it as a serious social problem.

Antihistamines are among the most widely used medications in the world. Ebastine is an antihistaminic which is long-acting, second-generation, and selective H1-receptor inverse agonist. I report a twelve-year-and-six-month-old girl with temporary prolongation of the QTc interval caused by acute ebastine intoxication due to TikTok challenge. Initial electrocardiogram showed sinus arrhythmia (72 beats/min) and prolongation of the QTc interval (QTc 482 milliseconds). Gastric lavage was performed. Intravenous fluid was administered, and activated charcoal (1 g/kg/per dose) was given. Electrocardiogram 9 h after drug ingestion showed sinus rhythm and normal QTc interval (QTc 414milliseconds). During follow-up, no electrocardiogram abnormalities were detected with electrocardiogram monitoring. She was discharged on day 2 without any complications. This case report is the first in the literature to show acute intoxication with ebastine due to challenge video on TikTok, which leads to a temporary prolongation of the QTc interval. Also, with this case report, I assert the fact that it is important to properly supervise the use of social media, such as TikTok and to review the content of TikTok videos.

Introduction: Suicidal thoughts and self-harm are disproportionately prevalent among older adults but are frequently overlooked by emergency physicians. Objective: This study aims to explore the characteristics of older adults visiting the ED for suicidal thoughts or voluntary intoxications. Methods: All older adults (□ 65 years old) who visited one of the five CHU de Quebec’ EDs in 2016 were eligible. The medical charts of patients who reported suicidal thoughts or intoxication in triage or received a relevant discharge diagnosis were reviewed. Involuntary intoxications were excluded. Descriptive statistics were used to present the results. Results: Results: A total of 478 ED visits were identified, of which 332 ED visits (n= 279 patients) were included. The mean age of the ED cohort was 72.6 (standard deviation 6.8) years old and 41.6% were female. Mood disorders (41.2%) and alcoholism (40.5%) were common. Most included patients had a diagnosis of voluntary intoxication (73.2%), including two suicides (0.6%). Following 109 ED visits (30.0%), patients were referred for a mental health assessment. Half of all ED visits resulted in a discharge by the emergency physician (50.0%), while 27.4% were admitted for in-patient care. In the subsequent year (2017), 38.4% returned to the ED for suicidal ideations or self-harm of which 7.9% attended the ED □ 5 times. Conclusion: ED visits for suicidal thoughts and voluntary intoxication in older adults are more common among men with known mood disorders or alcoholism. Referral for a mental health assessment is inconsistent. ED-initiated interventions designed for this population are needed.

Introduction: Emergency patients with decreased level of consciousness often undergo intubation purely for airway protection from aspiration. However, the true risk of aspiration is unclear and intubation poses risks. Anecdotally, experienced emergency physicians often defer intubation in these patients while others intubate to decrease the perceived clinical and medico-legal consequences. No literature exists on the intubation practices of emergency physicians in these cases. Methods: An online questionnaire was circulated to members of the Canadian Association of Emergency Physicians. Participants were asked questions regarding two common clinical cases with decreased level of consciousness : (1) acute, uncomplicated alcohol intoxication and (2) acute, uncomplicated seizure. For each case, providers’ perceptions of aspiration risk, the standard of care, and the need for intubation were assessed. Results: 128 of the 1546 Canadian physicians contacted (8.3%) provided responses. Respondents had a median of 15 years of experience, 88% had CCFP-EM or FRCPC certification, and most worked in urban centers. When intubating, 98% agreed they were competent and 90% agreed they were well supported. A minority (17.4%) considered GCS < 8 an independent indication for intubation. For the alcohol intoxication case, 88% agreed that aspiration risk was present but only 11% agreed they commonly intubate. Only 17% agreed intubation was standard care, and only 0.8% felt their colleagues always intubate such patients. For the seizure case, 65% agreed aspiration risk existed but only 3% agreed they commonly intubate, 1% felt colleagues always intubated, and 5% agreed intubation was standard of care. Additional factors felt to compel intubation (394 total) and support non-intubation (366 total) were compiled and categorized; the most common themes emerging were objective evidence of emesis or aspiration, other standard indications for intubation, head trauma, co-ingestions, co-morbidities and clinical instability. Conclusion: It is acceptable and standard practice to avoid intubating a select subset of intoxicated and post-seizure emergency department patients despite aspiration risk. Most physicians do not view the dogma of “GCS 8, intubate” as an absolute indication for intubation in these patients. Future research is aimed at identifying key factors and evidence supporting intubation for the prevention of aspiration, as well as the development of a validated clinical decision rule for common emergency presentations.

The different aspects of general safety of zolpidem are reviewed after analysing the safety data obtained in adults as well as in elderly patients. The low incidence of reported adverse events during the first three years of utilisation of zolpidem have corroborated the results of the clinical studies. The most frequent adverse effects are central nervous system (CNS) related but they can be largely prevented by respecting the recommended doses and prescription rules. In cases of acute overdoses, no severe complications have been attributed to zolpidem taken alone. In most of the studies carried out within the recommended treatment duration, abrupt treatment discontinuation was not associated with clinically significant rebound insomnia, and the available pre-clinical and clinical data indicate that the risk of abuse or dependence is minimal when prescribed according to the recommended doses of 10 mg in adults and 5 mg in elderly. Thus, with now well-established arguments on a large patient basis going in the same direction, the safety of zolpidem can authorise and justify its wide prescription in the short-term treatment of insomnia.

L’apparition et le développement de nouveaux produits de synthèse (NPS) constitue un défi pour la médecine d’urgence. En effet, en dehors des situations d’intoxications les plus courantes (alcool, benzodiazépines…), les services de médecine d’urgence sont de plus en plus fréquemment confrontés à de nouvelles manifestations toxiques aiguës dont les signes cliniques peuvent être très hétérogènes. Les médecins urgentistes sont généralement vigilants pour repérer un tableau évocateur d’un syndrome d’origine toxique ou toxidrome. Même s’il n’est pas spécifique, il représente le tableau caractéristique d’une intoxication, qui peut être variable selon la prise combinée de substances, ou de leurs produits de coupe, ou par la survenue de complications . Après un bref état des lieux sur l’épidémiologie de ces phénomènes aux urgences, nous proposons d’explorer les signes cliniques évocateurs des intoxications aux NPS qu’ils s’agissent en particulier des cannabinoïdes et cathinones de synthèse . Il s’agira par la suite de faire le point sur les réponses mises en place par les services d’urgences en ce qui concerne le repérage, l’enquête clinique et toxicologique et la prise en charge. Nous évoquerons enfin les modalités spécifiques d’interventions addictologiques et psychiatriques que ces nouvelles consommation impliquent en termes de soins et de préventions.

Carbon monoxide (CO) can cause mass intoxication, but no standard triage algorithm specifically addresses CO poisoning. The roles of some recent diagnostic tools in triage as well as treatment with hyperbaric oxygen are controversial. We describe a mass casualty case of CO poisoning involving 77 patients, with a focus on the triage and treatment options decided on-site. The reasons for choosing these options are reviewed, and the pitfalls that occurred and the lessons learned from this major incident are described. We discuss the potential to improve the management of such an event and strategies to accomplish this, including simplifying triage and administering oxygen to all exposed persons for 6 h. (Disaster Med Public Health Preparedness. 2018; 12: 373–378)