We recorded a slightly lower incidence than other European countries with the same epidemiological profile, except for a low incidence of acetaminophen cases. If we apply the European Association of Poisons Centres and Clinical Toxicologists gastric lavage criteria, there were an important number of unnecessary gut decontamination techniques in drug poisoning. Most patients were treated in emergency departments, without hospital admission.

Very few women are found either on editorial teams or in editor-in-chief positions in the emergency medicine journals, irrespective of the pre-eminence of the journal. It should be investigated whether a negative journal bias underlies these findings.

Objective We investigated the incidence, risk factors, clinical characteristics and outcomes of acute pancreatitis (AP) in patients with COVID‐19 attending the emergency department (ED), before hospitalization. Methods We retrospectively reviewed all COVID patients diagnosed with AP in 62 Spanish EDs (20% of Spanish EDs, COVID‐AP) during the COVID outbreak. We formed two control groups: COVID patients without AP (COVID‐non‐AP) and non‐COVID patients with AP (non‐COVID‐AP). Unadjusted comparisons between cases and controls were performed regarding 59 baseline and clinical characteristics and 4 outcomes. Results We identified 54 AP in 74,814 patients with COVID‐19 attending the ED (frequency=0.72‰, 95%CI=0.54‐0.94‰). This frequency was lower than in non‐COVID patients (2,231/1,388,879, 1.61‰, 95%CI=1.54‐1.67; OR=0.44, 95%CI=0.34‐0.58). Etiology of AP was similar in both groups, being biliary origin in about 50%. Twenty‐six clinical characteristics of COVID patients were associated with a higher risk of developing AP: abdominal pain (OR=59.4, 95%CI=23.7‐149), raised blood amylase (OR=31.8; 95%CI=1.60‐632) and vomiting (OR=15.8, 95%CI=6.69‐37.2) being the strongest, and some inflammatory markers (C‐reactive protein, procalcitonin, platelets, D‐dimer) were more increased. Compared to non‐COVID‐AP, COVID‐AP patients differed in 23 variables; the strongest ones related to COVID symptoms, but less abdominal pain was reported, pancreatic enzymes raise was lower, and severity (estimated by BISAP and SOFA score at ED arrival) was higher. The in‐hospital mortality (adjusted for age and sex) of COVID‐AP did not differ from COVID‐non‐AP (OR=1.12, 95%CI=0.45‐245) but was higher than non‐COVID‐AP (OR=2.46, 95%CI=1.35‐4.48). Conclusions Acute pancreatitis as presenting form of COVID‐19 in the ED is unusual (<1‰ cases). Some clinically distinctive characteristics are present compared to the remaining COVID patients and can help to identify this unusual manifestation. In‐hospital mortality of COVID‐AP does not differ from COVID‐non‐AP but is higher than non‐COVID‐AP, and the higher severity of AP in COVID patients could partially contribute to this increment.

Aims Benzodiazepines have been used as safe anxiolytic drugs for decades and some authors have suggested they could be an alternative for morphine for treating acute cardiogenic pulmonary oedema (ACPE). We compared the efficacy and safety of midazolam and morphine in patients with ACPE. Methods and results A randomized, multicentre, open‐label, blinded endpoint clinical trial was performed in seven Spanish emergency departments (EDs). Patients >18 years old clinically diagnosed with ACPE and with dyspnoea and anxiety were randomized (1:1) at ED arrival to receive either intravenous midazolam or morphine. Efficacy was assessed by in‐hospital all‐cause mortality (primary endpoint). Safety was assessed through serious adverse event (SAE) reporting, and the composite endpoint included 30‐day mortality and SAE. Analyses were made on an intention‐to‐treat basis. The trial was stopped early after a planned interim analysis by the safety monitoring committee. At that time, 111 patients had been randomized: 55 to midazolam and 56 to morphine. There were no significant differences in the primary endpoint (in‐hospital mortality for midazolam vs. morphine 12.7% vs. 17.9%; risk ratio[RR] 0.71, 95% confidence interval [CI] 0.29–1.74; p = 0.60). SAE were less common with midazolam versus morphine (18.2% vs. 42.9%; RR 0.42, 95% CI 0.22–0.80; p = 0.007), as were the composite endpoint (23.6% vs. 44.6%; RR 0.53, 95% CI 0.30–0.92; p = 0.03). Conclusion Although the number of patients was too small to draw final conclusions and there were no significant differences in mortality between midazolam and morphine, a significantly higher rate of SAEs was found in the morphine group.

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Objective To compare the severity of pulmonary embolism (PE) between patients with and without COVID, and to assess the association between severity and in-hospital-mortality. Methods We performed an analysis of 549 COVID (71.3% PCR-confirmed) and 439 non-COVID patients with PE consecutively included by 62 Spanish and 16 French emergency departments. PE-severity was assessed by size, the presence of right ventricular dysfunction (RVD), and the sPESI. The association of PE-severity and in-hospital-mortality was assessed both in COVID and non-COVID patients, and the interaction of COVID status and PE severity/outcome associations was also evaluated. Results COVID patients had PEs of smaller size (43% vs 56% lobar or larger, 42% vs. 35% segmental and 13% vs. 9% subsegmental, respectively; p = 0.01 for trend), less RVD (22% vs. 16%, p = 0.02) and lower sPESI ( p = 0.03 for trend). Risk of in-hospital death was higher in COVID patients (12.8% vs. 5.3%, p < 0.001). PE-severity assessed by RVD and sPESI was independently associated with in-hospital-mortality in COVID patients, while PE size and sPESI were significantly associated with in-hospital-mortality in non-COVID. COVID status showed a significant interaction in the association of PE size and outcome ( p = 0.01), with OR for in-hospital mortality in COVID and non-COVID patients with lobar or larger PE of 0.92 (95%CI=0.19–4.47) and 4.47 (95%CI=1.60–12.5), respectively. Sensitivity analyses using only PCR-confirmed COVID cases confirmed these results. Conclusion COVID patients present a differential clinical picture, with PE of less severity than in non-COVID patients. An increased sPESI was associated with the risk of mortality in both groups but, PE size did not seem to be associated with in-hospital mortality in COVID patients.

resUMenEn los últimos años han ganado popularidad una serie de nuevas drogas, conocidas como smart drugs o legal highs, fácilmente accesibles a través de tiendas online. Ello ocurre sobre todo en los segmentos jóvenes de la población, asociado a su consumo lúdico fundamentalmente durante los fines de semana.En general son derivados sintéticos de productos naturales, de los que apenas existe investigación clíni-ca y que no son detectables en los laboratorios de los hospitales.Tres de estos productos, el BZP (1-benzilpiperacina), la mefedrona (4-metilcatinona) y el Spice son probablemente los más utilizados en Europa. Los dos primeros se consumen como alternativas al éxtasis y la cocaína, y se caracterizan por producir un cuadro clíni-co de tipo simpaticomimético, en ocasiones de consecuencias graves, con convulsiones e incluso muerte. El Spice (mezcla de hierbas con cannabinoides sintéticos como el JWH-018, el JWH-073 y el CP 47,497-C8) está ocasionando cuadros de dependencia y esquizofrenia.Aunque las drogas emergentes poseen un aura de seguridad, cada vez hay más experiencia sobre sus efectos secundarios.Palabras clave. Smart-drugs. Piperacinas. Catinonas. Mefedrona. Spice.