Glucagon is frequently used for the relief of esophageal impactions. This systematic review and metaanalysis were performed to evaluate the efficacy and safety of glucagon for acute esophageal foreign body and food impactions. PubMed, CINAHL, Latin American and Caribbean Health Sciences Literature (LILACS), Scopus, Cochrane Database of Systematic Reviews, and Cochrane Central Register of Controlled Trials were searched from inception to March 1, 2018. Retrospective, observational, and randomized controlled trials assessing glucagon for the relief of acute esophageal foreign body and food impaction were included. There were no language or age restrictions. Only studies conducted on humans and with a comparator (e.g., control or placebo) were included. Study quality analysis was performed using the Cochrane Risk of Bias tool. Quality of evidence analysis was performed using the Grading of Recommendations, Assessment, Development and Evaluations approach. A total of 1988 studies were identified, and five studies with a total of 1185 subjects were included. Treatment success occurred in 213 of 706 (30.2%) patients in the glucagon group and 158 of 479 (33.0%) patients in the control group (odds ratio [OR] 0.90, 95% confidence interval [CI] 0.69-1.17, p=0.42). There was minimal statistical heterogeneity (I 2 = 14%, p=0.33). No publication bias was identified. Adverse events were identified in 24 (15.0%) patients in the glucagon group and 0 (0%) patients in the placebo group (risk difference [RD] 0.18, 95% CI 0.03-0.33, p=0.02). Vomiting events occurred more frequently in the glucagon group (17 of 160 [10.6%] vs 0 of 53 [0%]) but was not statistically significant (RD 0.07, 95% CI -0.03-0.17, p=0.19). Glucagon was not associated with a difference in treatment success but had a higher rate of adverse events for the treatment of esophageal foreign body and food impaction. Further controlled studies are needed to confirm the efficacy of glucagon with adequate power to assess adverse events.

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We report the case of a 54-year-old female with intentional pregabalin 3825 mg ingestion that resulted in a rare adverse effect of a witnessed seizure with confirmatory serum concentrations. After presenting alert to the emergency department she became obtunded, only responding to sternal rub (four hours after ingestion). Laboratory evaluation and toxicology panel were unremarkable. Approximately eight hours after the ingestion she had physician-witnessed tonicclonic seizure activity with right gaze deviation for 90 seconds. This is only the third documented case of paradoxical seizure due to a large overdose of pregabalin. Also, the serum concentration observed is among the highest recorded (58 mcg/mL five hours post-ingestion). Pregabalin abuse has been emerging. Clinical toxicologists should be aware of the potential of pregabalin-induced seizures following overdose.

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IntroductionBurnout syndrome is a prolonged response to chronic emotional and interpersonal stressors and is becoming an increasing concern in the medical community. Burnout in emergency medicine (EM) pharmacists has not been previously assessed.ObjectivesTo identify the prevalence of burnout among EM pharmacists, in addition to demographic, professional, seasonal, and job‐related associations.MethodsPharmacists practicing greater than 50% of their time in the emergency department (ED) setting were invited through the American College of Clinical Pharmacy Emergency Medicine Practice and Research Network listserv to complete a survey at three separate, 4‐week, time periods (July 2018, October 2018, and April 2019). The survey contained the Maslach Burnout Inventory for Medical Personnel to detect burnout. Questions regarding personal and job‐specific demographics were asked. Descriptive statistics were used to report demographics and burnout dimensions in each period. Spearman's rank correlation and univariate and multivariate analyses were performed to identify predictors of burnout and potential associations.ResultsA total of 485 surveys were completed across all periods (116 [July], 207 [October], 162 [April]) and response rates were 18.4%, 31.6%, and 22.7%, respectively. Burnout was identified in 69.8%, 67.1%, and 68.5% of respondents with no difference between periods. A majority of participants had high depersonalization scores (50.6‐76.3%) during the three survey periods.Younger age, more ED visits per year, level I trauma center designation, and lower percentage of direct patient care time were associated with increased odds of burnout in the July 2018 period. Intent to leave one's current position or the specialty of EM and consideration of a job with different hours had positive correlations with burnout.ConclusionsBurnout is prevalent in a majority of EM pharmacists throughout the year. It is difficult to identify exact predictors of burnout; however, potential contributors include age, trauma center designation, patient volumes, and direct patient care time.