Odd Martin Vallersnes

Recreational drugs affect the cardiovascular system through distinct mechanisms; however, data regarding their cardiovascular impact in the emergency department setting is limited. This study aimed to assess the incidence of cardiovascular effects following recreational drug use in presentations to the emergency department, identify the main drug groups involved, and compare cases with and without cardiovascular effects. Data were extracted from the European Drug Emergency Network (Euro-DEN Plus) dataset from October 2013 to December 2021. Recreational drugs were categorised into ten main drug groups: opioids, cocaine, crack cocaine, cannabis, 3,4-methylenedioxymethamfetamine, amfetamine-type stimulants, gamma-hydroxybutyrate and gamma-butyrolactone, hallucinogens, benzodiazepines, and ketamine. Among 59,571 presentations, 13,905 (23.3%) involved cardiovascular effects. Cocaine (OR 3.19, 95% CI 2.99-3.39) and 3,4 methylenedioxymethamphetamine (OR 1.18, 95% CI 1.13-1.23) showed the strongest associations with cardiovascular features, including chest pain, palpitations, hypertension, and arrhythmias. Opioids (OR 0.35, 95% CI 0.31-0.38) and benzodiazepines (OR 0.38, 95% CI 0.32-0.44) were associated with less frequent cardiovascular features. Patients with cardiovascular features exhibited higher median values for temperature, heart rate, blood pressure, and respiratory rate (p <0.001). Cardiovascular features were associated with an increased risk of intubation (OR 1.91, 95% CI 1.70-2.15), critical care admission (OR 2.18, 95% CI 2.00-2.38), and mortality (OR 15.8, 95% CI 7.36-33.9). Cardiovascular effects were common in acute recreational drug toxicity. Cocaine and amfetamine-type stimulants increased the risk of chest pain and arrhythmias, with chest pain being a key indicator of acute coronary syndrome. Cardiovascular effects were more frequently observed with cocaine than with crack cocaine. Cannabis was positively associated with palpitations but not arrhythmias. Gamma-hydroxybutyrate and gamma-butyrolactone, opioids, and benzodiazepines were linked to hypotension. The presence of cardiovascular effects was associated with worse outcomes, underscoring the need for thorough cardiac assessment. Cardiovascular effects were present in almost a quarter of emergency department presentations with acute recreational drug toxicity, particularly involving cocaine and 3,4 methylenedioxymethamphetamine.

People with severe substance use (PWSSU) face increased health risks, which contributes to higher mortality rates and reduced life expectancy. Concurrent harmful alcohol use may further exacerbate these risks but is often overlooked in this population. The aim of this study was to assess levels of harmful alcohol use among PWSSU. Participants were recruited from two sites in Oslo, Norway, that either shelters and/or treats PWSSU. Alcohol and substance use was assessed with self-report questionnaires and a blood sample. The blood sample was analyzed for 20 commonly used illicit and medicinal substances, ethanol and phosphatidylethanol (PEth). Harmful alcohol use was defined as AUDIT-4 ≥ 7 (men)/≥5 (women), having PEth concentration ≥ 300 nM, or both. Associations between harmful alcohol use and sex, age, and substance use profile were assessed. Of the 165 participants (70% male) included in the study, most (n = 94, 57%) stated opioids as their main substance, and polysubstance use was common (median substances in blood samples = 5). Alcohol use in the last 12 months was reported by 75% (n = 125) of the participants. Harmful alcohol use was detected in 28 (24%) of male participants and 23 (47%) of female participants. Being female, decreasing age, and reporting a non-opioid as main substance were associated with harmful alcohol use. A harmful drinking pattern was frequently observed among PWSSU, especially among women. In addition to treating excessive substance use in this underserved group, reduction of harmful alcohol use would be beneficial to reduce health risk.

Sexual assault is associated with serious health consequences. Tailored medical follow-up after a sexual assault can be crucial during this difficult time and can help prevent long-term health problems. We aimed to examine attendance and non-attendance at medical follow-up appointments at the Sexual Assault Centre in Oslo, and whether those who initially failed to attend did so after contact had been re-established. As a quality improvement project, we conducted a retrospective observational study of patients at the Sexual Assault Centre in Oslo in 2022. Medical records up to and including 26 weeks after presentation were reviewed. We recorded attendance and non-attendance for medical follow-up appointments, and whether patients who had not initially attended subsequently did so after contact had been re-established. Of the 579 patients who accepted medical follow-up, 275 (47.5 %) attended their planned follow-up appointments. Attempts were made to re-establish contact with 274 patients, and of these, 169 (61.7 %) attended one or more follow-up appointments. Overall, 444 of 579 (76.7 %) attended one or more follow-up appointments. The findings suggest that by re-establishing contact with patients who miss appointments, the Sexual Assault Centre helps ensure more individuals receive medical care after a sexual assault.

Treating patients with drug and alcohol poisoning requires knowledge of which substances are involved. We describe drug and alcohol poisonings at Oslo Accident and Emergency Outpatient Clinic (OAEOC) in the period 2019-23. Cases of drug and alcohol poisoning (as opposed to unique patients) treated at OAEOC between 2019 and 2023 were retrospectively retrieved from the clinic's medical record system. Diagnoses were based on the treating doctor's clinical assessment as recorded in the patient's notes. Incidence rates were calculated based on the population of Oslo municipality aged ≥ 12 years. In the period 2019-2023, OAEOC treated 18,402 cases of drug and alcohol poisoning, of which 8981 (49 %) were due to the consumption of pure ethanol. The overall incidence of drug and alcohol poisonings increased from 6.32 per 1000 inhabitants in 2019 to 6.68 in 2023, with a low point of 5.36 in 2021. The incidence of pure ethanol poisoning was 3.10 in 2019 and 3.06 in 2023, with a low point of 2.53 in 2020. Over the five-year period, the incidence of cocaine poisonings rose from 0.28 to 0.70, and ketamine poisonings from 0.01 to 0.12. The proportion of women increased from 33 % to 39 % for pure ethanol poisoning, and from 20 % to 31 % for other drug and alcohol poisonings. The incidence of drug and alcohol poisonings treated at OAEOC increased from 2019 to 2023, with a temporary decline during the COVID-19 pandemic.

Patients poisoned with gamma-hydroxybutyrate may need urgent medical treatment. The clinical manifestations are heterogeneous, and the level of consciousness is often unstable, with fluctuations between agitation and coma. We aimed to investigate the accuracy of the clinical diagnosis of gamma-hydroxybutyrate poisoning compared to laboratory findings in blood samples. We did a prospective observational study, including patients ≥16 years of age admitted to hospital with a clinical diagnosis of gamma-hydroxybutyrate poisoning. The diagnosis was established by the doctor treating the patient based on the clinical information and/or information from the patient and/or the patient's companions. Blood samples were taken at admission and analyzed using ultra high-performance liquid chromatography-tandem mass spectrometry. There were 87 patients with a median age of 35 years (IQR: 30-42 years), and 58.6% (51/87) were male. Gamma-hydroxybutyrate was found in blood samples taken from 60 (69.0%) patients. The median Glasgow Coma Scale of all patients on arrival at hospital was 6 (IQR: 3-10), and 53.3% of the patients who tested positive for gamma-hydroxybutyrate presented with a Glasgow Coma Scale of 3. The Glasgow Coma Scale was significantly lower (P <0.001) among patients who tested positive for gamma-hydroxybutyrate, and was inversely correlated with gamma-hydroxybutyrate concentrations. Among the 60 patients testing positive for gamma-hydroxybutyrate, 28 (46.7%) needed treatment in an intensive care unit, and three (5.0%) required endotracheal intubation. In 58 (96.7%) of the 60 patients who tested positive for gamma-hydroxybutyrate, other drugs were also found, most frequently amfetamines, cocaine, and benzodiazepines. The frequent co-consumption of other psychoactive drugs makes the clinical diagnosis of gamma-hydroxybutyrate challenging, and poisoning with other central nervous system depressants was frequently observed among those patients testing negative for the gamma-hydroxybutyrate. In only two out of three patients with clinically suspected gamma-hydroxybutyrate poisoning was gamma-hydroxybutyrate found in a blood sample, indicating that clinicians might overdiagnose gamma-hydroxybutyrate poisoning.

This study hypothesized that 3,4-methylenedioxymetamfetamine intoxication presents with distinct clinical features and outcomes when combined with other substances of misuse, compared to mono-3,4-methylenedioxymetamfetamine intoxication. This study investigated the clinical presentation of acute mono-3,4-methylenedioxymetamfetamine intoxication, 3,4-methylenedioxymetamfetamine intoxication with exclusive co-usage of ethanol, and 3,4-methylenedioxymetamfetamine-co-intoxication with co-usage of other substances with or without ethanol, with a focus on patient sex differences. A retrospective analysis was conducted using the Euro-DEN Plus database (2013-2022), which collects data on emergency department presentations with acute drug intoxication from 28 sentinel centres in 18 European countries. Odds ratios for clinical features were calculated for the three study groups with mono-3,4-methylenedioxymetamfetamine intoxication as the reference group. A sub-analysis explored patient sex differences in clinical features. Among 4,102 presentations, 3,4-methylenedioxymetamfetamine-ethanol intoxication (n = 1,376) was associated with increased odds of agitation (OR: 1.34), drowsiness (OR: 2.30), and vomiting (OR: 1.85) compared to mono-3,4-methylenedioxymetamfetamine intoxication (n = 359). 3,4-Methylenedioxymetamfetamine-co-intoxication (n = 2,367) was associated with higher odds of bradycardia (OR: 3.14), psychosis (OR: 1.91), and coma (OR: 1.72). Mortality rates did not significantly differ across groups. Females reported a lower incidence of chest pain (OR 0.78) while reporting higher rates of vomiting (OR: 1.64), headache (OR: 1.61), and hypotension (OR: 1.89) compared to males. The variation in clinical manifestation of acute 3,4-methylenedioxymetamfetamine intoxication is associated with co-intoxication and patient sex. Co-intoxication with ethanol or other substances was associated with an increased incidence of more severe symptoms, such as agitation and psychosis, necessitating tailored management. These variations suggest the need for physicians to consider the type of co-intoxication and patient sex to optimize treatment strategies. Although co-intoxication affected the clinical trajectory, the mortality risk remains low. Ethanol co-intoxication, co-intoxication with other substances of misuse, and patient sex were associated with varying clinical presentations in the emergency department, necessitating tailored treatment approaches.

Acute chest pain has a high hospital referral rate due to the limited ability to exclude acute myocardial infarction (MI) in primary care. We aimed to evaluate the effectiveness of implementing the European Society of Cardiology (ESC) 0/1-hour algorithm for high-sensitivity cardiac troponin T (hs-cTnT) testing in emergency primary care. In a prospective study (April-October 2023), the ESC 0/1-hour algorithm for hs-cTnT was implemented at the main emergency primary care clinic in Oslo, Norway. All consecutive patients ≥ 18 years with acute non-traumatic chest pain having hs-cTnT measurements done were registered. The patients were assigned to MI rule-out, rule-in, or further observation using the algorithm. Patients in the observation group had a 4-hour hs-cTnT measurement done. The outcome measures were the proportion of patients conclusively assessed by the protocol, personnel adherence, reduction in length of stay (LOS) compared to the previous 0/4-hour protocol (historical cohort), and disposition. During six months, hs-cTnT measurements were conducted in 32.6% (995/3053) of chest pain patients (median age 58 years (IQR 45–68); 50.6% female). A single hs-cTnT measurement assigned 24.1% (n = 240/995) towards MI rule-out, suitable for early discharge, increasing to 63.8% after adding a 1-hour measurement. The observation group (319/995, 32.1%) was reduced to 23.0% (229/995) after a 4-hour measurement. A total of 77.0% of the patients were conclusively assigned to either rule-out or rule-in group. The personnel adhered well to the new protocol, with a median 1-hour sampling interval of 63 min (IQR 60–66) and 4.6 h (IQR 4.1–5.5) for the 4-hour sample. The protocol was misinterpreted or overruled in 8.6% of the cases. Compared to the previous 0/4-hour protocol, LOS was reduced by -2.2 h (95% confidence intervals − 2.6 to -1.7). After completed assessment at the clinic, 14.8% were transferred to hospital, where 20 patients were diagnosed with an MI. The remaining patients were sent home or managed in the outpatient setting; any occurrence of MIs in this group is unknown. The ESC 0/1-hour algorithm effectively assesses low-risk acute chest pain in emergency primary care, reinforcing its gatekeeper role by managing these patients at a lower level of care.