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1. The Opioid Crisis in Missouri: A Call to Action for Physicians, Legislators, and Society

Author

Lawrence, Lewis, Christopher R, Carpenter, Evan S, Schwarz, Randall S, Jotte, Corey, Waller, Rachel, Winograd, Randall, Williams, Steven, Stenger, Holly, Rehder, Shannon, Governick, and Luis, Giuffra

Subjects
Analgesics, Opioid, Missouri, Physicians, Science of Medicine, Humans, Drug Overdose, Epidemics, Opioid-Related Disorders, State Government
Abstract

Opioid overdose deaths in the United States increased sharply over the last decade leading the President to declare a national emergency. The neurobiology of opioid addiction is explored in conjunction with the historical events preceding the current epidemic. A patient-centric perspective is provided along with rationale for contemporary Medical Assisted Therapy (MAT) options to safely reduce overdose deaths and other preventable consequences of prescription misuse and heroin abuse. A multidisciplinary medical provider approach is essential, in addition to legislative efforts to reduce current regulatory burdens that reduce access to MAT in many settings. This review introduces a new Missouri Medicine series intended to explore key concepts to simultaneously reduce opioid prescribing, while effectively managing acute and chronic pain across complex healthcare settings.

Published
2018

2. Contributors

Author

Michael K. Abraham, Fredrick M. Abrahamian, Mohammed A. Abu Aish, Bruce D. Adams, James G. Adams, Nima Afshar, James Ahn, Amer Z. Aldeen, Paul J. Allegretti, Jennifer F. Anders, Jana L. Anderson, Phillip Andrus, Christian Arbelaez, Charles B. Arbogast, Chandra D. Aubin, Jennifer Avegno, John Bailitz, Patricia Baines, Aaron E. Bair, Katherine Bakes, Aaron N. Barksdale, William G. Barsan, Erik D. Barton, Benjamin S. Bassin, Craig G. Bates, Jamil D. Bayram, Tomer Begaz, Kip Benko, Kavita Bhanot, Kriti Bhatia, Paul D. Biddinger, Andra L. Blomkalns, John M. Boe, J. Stephen Bohan, Keith Boniface, Laura J. Bontempo, Pierre Borczuk, Keith Borg, Nicholas A. Borm, Philip Bossart, Megan Boysen Osborn, William J. Brady, Jeremy B. Branzetti, Bart S. Brown, David F.M. Brown, Sean M. Bryant, John H. Burton, Christine Butts, Mark W. Byrne, Daniel Cabrera, Robert D. Cannon, David A. Caro, Christopher R. Carpenter, Wallace A. Carter, Cindy W. Chan, Gar Ming Chan, Andrew K. Chang, Douglas M. Char, Navneet Cheema, Yi-Mei Chng, Michael R. Christian, Richard F. Clark, Kathleen J. Clem, James E. Colletti, Jamie L. Collings, Christopher B. Colwell, Justin Cook, Jeremy L. Cooke, Julie J. Cooper, D. Mark Courtney, Kirk L. Cumpston, Rita K. Cydulka, Lynda Daniel-Underwood, Elizabeth M. Datner, Jonathan E. Davis, Virgil Davis, Mae F. De La Calzada-Jeanlouie, Sarah Steward de Ramirez, Peter M.C. DeBlieux, Wyatt W. Decker, Jorge del Castillo, John Deledda, Eva M. Delgado, M. Kit Delgado, Margaret M. DiGeronimo, Gail D’Onofrio, Gerard S. Doyle, Bradley A. Dreifuss, Jeffrey Druck, Jonathan A. Edlow, Jeffrey M. Elder, Kirsten G. Engel, Ugo A. Ezenkwele, Jessica A. Fulton, Fiona E. Gallahue, Manish Garg, Gus M. Garmel, Ryan T. Geers, Carl A. Germann, Chris A. Ghaemmaghami, Michael A. Gibbs, Gregory H. Gilbert, Michael A. Gisondi, Steven A. Godwin, Joshua N. Goldstein, Eric Goralnick, Deepi G. Goyal, Matthew N. Graber, David D. Gummin, Geetika Gupta, Todd A. Guth, Azita G. Hamedani, Abigail D. Hankin, Benjamin P. Harrison, Stephen C. Hartsell, Tarlan Hedayati, Alan C. Heffner, Diane B. Heller, Robin R. Hemphill, Gregory L. Henry, H. Gene Hern, Sheryl L. Heron, Cherri D. Hobgood, Beatrice Hoffmann, Lance H. Hoffman, Christy Hopkins, Russ Horowitz, Debra E. Houry, David S. Howes, J. Stephen Huff, James Q. Hwang, Eric Isaacs, Benjamin F. Jackson, Andy Jagoda, Edward C. Jauch, Kerin A. Jones, Randall S. Jotte, Christopher S. Kang, Jacqueline Khorasanee, Christopher S. Kiefer, Tae Eung Kim, Heidi H. Kimberly, Matthew Kippenhan, Niranjan Kissoon, Kevin Klauer, Frederick Korley, Joshua M. Kosowsky, Karen Nolan Kuehl, Thomas Kunisaki, Shana Kusin, Michael Lambert, Patrick M. Lank, Erin M. Lareau, Sara Lary, Erik G. Laurin, Holly K. Ledyard, Eric L. Legome, Tracy Leigh LeGros, Katrina A. Leone, Matthew R. Levine, Michael Levine, Jason E. Liebzeit, Michelle Lin, M. Scott Linscott, Suzanne Lippert, John B. Lissoway, Robert Lockwood, Heather Long, Dave W. Lu, Binh T. Ly, Catherine A. Lynch, Troy E. Madsen, Swaminatha V. Mahadevan, Mamta Malik, Haney A. Mallemat, Michael P. Mallin, Gerald Maloney, Nicole Malouf, Rita A. Manfredi, David E. Manthey, Keith A. Marill, Melissa Marinelli, Joseph P. Martinez, Amal Mattu, Anna K. McFarlin, Mark McIntosh, Candace D. McNaughton, Ron Medzon, Carl R. Menckhoff, Glen E. Michael, Nathan W. Mick, Lisa D. Mills, Trevor J. Mills, Peter P. Monteleone, Raveendra S. Morchi, Lisa Moreno-Walton, Elizabeth A. Mort, Thomas Morrissey, Heather Murphy-Lavoie, Mark B. Mycyk, Eric S. Nadel, Swathi Nadindla, Brian K. Nelson, Lewis S. Nelson, Sara W. Nelson, David H. Newman, Bret A. Nicks, Vicki E. Noble, Joshua N. Nogar, Robert L. Norris, Ashley Booth Norse, Robert E. O’Connor, Kelly P. O’Keefe, Haru Okuda, Brian W. Patterson, Leigh A. Patterson, Richard Paula, Joseph F. Peabody, David A. Peak, John Nelson Perret, Andrew D. Perron, Vanessa Maria Piazza, Robert F. Poirier, Emilie S. Powell, Susan B. Promes, Tammie E. Quest, James Quinn, Claudia Ranniger, Niels K. Rathlev, James W. Rhee, Keri Robertson, Matthew T. Robinson, Robert L. Rogers, Carlo L. Rosen, Christopher Ross, Scott E. Rudkin, Anne-Michelle Ruha, Michael S. Runyon, Annie T. Sadosty, Tracy G. Sanson, Jairo I. Santanilla, Sally A. Santen, Osman R. Sayan, Michael J. Schmidt, Kathleen S. Schrank, Jeremiah D. Schuur, Theresa Schwab, Wesley H. Self, Monique I. Sellas, Andrew W. Shannon, Ghazala Q. Sharieff, Rahul Sharma, Philip Shayne, Ashley Shreves, Amandeep Singh, Ellen M. Slaven, Mark Sochor, Mitchell C. Sokolosky, Jeremy D. Sperling, Sarah A. Stahmer, Robert L. Stephen, Brian A. Stettler, Matthew Strehlow, Mark Su, Amita Sudhir, D. Matthew Sullivan, Jeffrey Tabas, Taku Taira, James K. Takayesu, Asim F. Tarabar, Danny G. Thomas, Kristine M. Thompson, Trevonne M. Thompson, Stephen Thornton, T. Paul Tran, Jacob Ufberg, Andrew S. Ulrich, Michael C. Wadman, Ernest E. Wang, N. Ewen Wang, Danielle M. Ware-McGee, Ian S. Wedmore, Natasha Wheaton, Beranton Whisenant, Max Wintermark, Michael E. Winters, Stephen J. Wolf, Richard E. Wolfe, Todd Wylie, Christine Yang-Kauh, Timothy P. Young, Steven M. Zahn, Cristina M. Zeretzke, David K. Zich, and Amy E. Zosel

Published
2013

3. Addiction

Author

Randall S. Jotte

Published
2013

4. Raynaud's phenomenon in the emergency department

Author

Brian J. Browne, Michael A. Rolnick, and Randall S. Jotte

Subjects
medicine.medical_specialty, education.field_of_study, business.industry, Vascular disease, Population, Raynaud Disease, Vasospasm, Emergency department, medicine.disease, Scleroderma, Surgery, Pain control, Vasoconstriction, Emergency Medicine, medicine, Humans, Tissue necrosis, Female, Emergencies, Intensive care medicine, education, business, Patient education
Abstract

Raynaud's phenomenon manifests as triphasic color changes of the digits, induced by exposure to low temperature or emotional stress. It is a relatively common disorder, estimated to affect 5% to 10% of the general population and 25% to 30% of otherwise healthy women. Although usually self-limiting, it can be severely painful and debilitating, and complicated by ulcerations and tissue necrosis. For the emergency physician treating a patient with an acute presentation of the phenomenon, the main challenges are to achieve adequate pain control, reverse vasospasm, and maintain viable tissue. Emergency treatment can also extend to patient education and arrangement of appropriate referrals and follow-up care.

Published
1995

5. Esophageal apoplexy: Case report, review, and comparison with other esophageal disorders

Author

Randall S. Jotte

Subjects
Adult, Male, medicine.medical_specialty, Resuscitation, Hemorrhage, Esophageal Disorder, Esophageal Diseases, Esophageal Hemorrhage, Diagnosis, Differential, medicine, Humans, Esophagus, Mallory–Weiss syndrome, Mallory-Weiss Syndrome, Rupture, Spontaneous, Esophageal disease, Esophageal wall, business.industry, General surgery, medicine.disease, Surgery, Radiography, medicine.anatomical_structure, Esophagus perforation, Emergency Medicine, business
Abstract

Esophageal injuries are potentially serious disorders requiring prompt recognition and management. In addition to the well-recognized Mallory-Weiss and Boerhaave's syndromes, there exists a condition of spontaneous intramural esophageal hemorrhage: esophageal apoplexy. A case of esophageal apoplexy is presented as well as an evaluation of clinical presentations based on a collected review of the 66 cases previously reported. In addition, esophageal apoplexy is contrasted with the Mallory-Weiss and Boerhaave's syndromes, focusing on distinguishing attributes of utility to the emergency practitioner.

Published
1991

6. Malaria: review of features pertinent to the emergency physician

Author

James Scott and Randall S. Jotte

Subjects
Adult, medicine.medical_specialty, medicine.medical_treatment, Plasmodium vivax, Drug Resistance, Exchange Transfusion, Whole Blood, Exchange transfusion, Parasitemia, Amodiaquine, Diagnosis, Differential, Antimalarials, Pharmacotherapy, Clinical Protocols, Chloroquine, parasitic diseases, medicine, Humans, Intensive care medicine, Child, Quinine, biology, business.industry, biology.organism_classification, medicine.disease, Surgery, Malaria, Emergency Medicine, business, medicine.drug
Abstract

Malaria is a health problem of growing concern to the emergency physician. Plasmodium vivax, P ovale, and P malaria infections are relatively benign and can be treated in an outpatient setting with oral chloroquine or amodiaquine. In contrast, P falciparum can present fulminantly, often resulting in death with multiple organ system failure. Although quinine historically has been the mainstay of therapy for severe falciparum malaria in the United States, and still is outside the U.S., quinidine gluconate as a continuous infusion is currently recommended as the agent of choice for severe P falciparum infection. In addition to the rapid administration of appropriate chemotherapeutic agents and the institution of aggressive supportive care, exchange transfusion may be utilized as a means of rapidly reducing the parasitemia and consequently, the mortality.

Published
1993

7. A Bridge to Nowhere? Challenging Outpatient Transitions of Care for Acute Pain Patients in the Opioid Epidemic Era.

Author

Carpenter CR, Lewis L, Jotte RS, and Schwarz ES

Subjects
Epidemics, Humans, Outpatients, Practice Patterns, Physicians', United States epidemiology, Acute Pain drug therapy, Analgesics, Opioid therapeutic use, Opioid-Related Disorders epidemiology, Pain Management methods, Transitional Care
Abstract

Opioid misuse is reducing Americans' life expectancy, thereby catalyzing professional societies and legislators to action. Efforts to combat the opioid epidemic must work hand-in-hand with appropriate efforts to reduce the severity and duration of suffering. Pharmacologic analgesia is temporizing. Current opioid prescribing guidelines focus on reducing the frequency and quantity of narcotics prescribed, but lack attention to alleviation of the source of pain. Conditions eliciting acute pain sometimes require additional specialist management following discharge from the emergency department. Patients frequently lack timely access to these specialists, particularly if underinsured. This essay explores acute dental pain, extremity fractures, and back pain as three common examples whereby complex healthcare systems must efficiently adapt in order to serve the dual objectives of reducing the risk of opioid-related adverse consequences and minimizing the duration of patient suffering.

Published
2018

8. The Opioid Crisis in Missouri: A Call to Action for Physicians, Legislators, and Society.

Author

Lewis L, Carpenter CR, Schwarz ES, Jotte RS, Waller C, Winograd R, Williams R, Stenger S, Rehder H, Governick S, and Giuffra L

Subjects
Drug Overdose mortality, Epidemics, Humans, Missouri epidemiology, Opioid-Related Disorders mortality, Opioid-Related Disorders physiopathology, Opioid-Related Disorders prevention & control, Physicians, State Government, Analgesics, Opioid adverse effects, Opioid-Related Disorders epidemiology
Abstract

Opioid overdose deaths in the United States increased sharply over the last decade leading the President to declare a national emergency. The neurobiology of opioid addiction is explored in conjunction with the historical events preceding the current epidemic. A patient-centric perspective is provided along with rationale for contemporary Medical Assisted Therapy (MAT) options to safely reduce overdose deaths and other preventable consequences of prescription misuse and heroin abuse. A multidisciplinary medical provider approach is essential, in addition to legislative efforts to reduce current regulatory burdens that reduce access to MAT in many settings. This review introduces a new Missouri Medicine series intended to explore key concepts to simultaneously reduce opioid prescribing, while effectively managing acute and chronic pain across complex healthcare settings.

Published
2017

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