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A high incidence of honey oil and methamphetamine production has led to an increase in burn victims presenting to this regional burn center in California. This study aims to compare patient outcomes resulting from burn injuries associated with honey oil and methamphetamine production. This is a retrospective cohort study using the regional burn registry to identify patients with burn injuries related to honey oil production or methamphetamine purification explosions from January 1, 2008 to December 31, 2017. Patient demographics and clinical outcomes data were abstracted from the burn registry and medical records. A total of 91 patients were included in the final analysis and 59.3% (n = 54) were related to honey oil injury. There was no statistically significant difference between honey oil and methamphetamine burn injuries in regard to clinical outcomes, including mortality (1.9% vs 8.1%, P = .1588), third-degree burn (47.2% vs 59.5%, P = .2508), mechanical ventilator usage (50% vs 69.4%, P = .0714), median hospital length of stay (LOS; 10 vs 11 days, P = .5308), ICU LOS (10 vs 11 days, P = .1903), total burn surface area (26.5% vs 28.3%, P = .8313), and hospital charge (median of US$85,561 vs US$139,028, P = .7215). Honey oil burn injuries are associated with similar hospital LOS, similar ICU LOS, similar total burn surface area, and present a costly public health concern. With the recent legalization of marijuana in California, commercial production of honey oil in addition to increasing education about the risks of illicit honey oil production may alleviate associated risks.

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Neuroleptic malignant syndrome (NMS) is a rare but potentially fatal complication resulting from neuroleptic drug therapy. Presentation of NMS can vary, and diagnosis relies primarily upon medical history and symptomatology. Due to the potential delay in diagnosis, emergency physicians should remain vigilant in recognizing the symptoms of NMS and be prepared to initiate immediate treatment following diagnosis. Dantrolene, which has been used for spasticity and malignant hyperthermia, has been reported as a potential treatment for NMS and led to off-label use for NMS. We report two cases of NMS induced by antipsychotic monotherapy for which dantrolene was administered.

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INTRODUCTION: Hemorrhage is one of the leading causes of death in trauma victims. Historically, paramedics have not had access to medications that specifically target the reversal of trauma-induced coagulopathies. The California Prehospital Antifibrinolytic Therapy (Cal-PAT) study seeks to evaluate the safety and efficacy of tranexamic acid (TXA) use in the civilian prehospital setting in cases of traumatic hemorrhagic shock. METHODS: The Cal-PAT study is a multi-centered, prospective, observational cohort study with a retrospective comparison. From March 2015 to July 2017, patients ≥ 18 years-old who sustained blunt or penetrating trauma with signs of hemorrhagic shock identified by first responders in the prehospital setting were considered for TXA treatment. A control group was formed of patients seen in the five years prior to data collection cessation (June 2012 to July 2017) at each receiving center who were not administered TXA. Control group patients were selected through propensity score matching based on gender, age, Injury Severity Scores, and mechanism of injury. The primary outcome assessed was mortality recorded at 24 hours, 48 hours, and 28 days. Additional variables assessed included total blood products transfused, the hospital and intensive care unit length of stay, systolic blood pressure taken prior to TXA administration, Glasgow Coma Score observed prior to TXA administration, and the incidence of known adverse events associated with TXA administration. RESULTS: We included 724 patients in the final analysis, with 362 patients in the TXA group and 362 in the control group. Reduced mortality was noted at 28 days in the TXA group in comparison to the control group (3.6% vs. 8.3% for TXA and control, respectively, odds ratio [OR]=0.41 with 95% confidence interval [CI] [0.21 to 0.8]). This mortality difference was greatest in severely injured patients with ISS >15 (6% vs 14.5% for TXA and control, respectively, OR=0.37 with 95% CI [0.17 to 0.8]). Furthermore, a significant reduction in total blood product transfused was observed after TXA administration in the total cohort as well as in severely injured patients. No significant increase in known adverse events following TXA administration were observed. CONCLUSION: Findings from the Cal-PAT study suggest that TXA use in the civilian prehospital setting may safely improve survival outcomes in patients who have sustained traumatic injury with signs of hemorrhagic shock.

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