Biomedical subjects

B S Dean

Publications and source records attributed to B S Dean.

At least 55 records · Page 3Linked to original sources

PubMed1989

Motor vehicles as a site of accidental poisonings.

Although most poisonings occur within the home, the toxic agents involved are customarily transported there by motor vehicles. Over a 9-month period, all potentially toxic exposures reported to a poison information center that occurred in a motor vehicle were collected. Common toxins were identified and associated incidence and risk were assessed; 68% were pediatric exposures and the remainder were in adults. The adult exposures were dermal and via inhalation, whereas the pediatric exposures were predominantly inhalation (44%) and ingestion (36%). Inhalant toxins included carbon monoxide (CO) (13%), fire extinguishers (48%), and hydrocarbons (17%). Ingested toxins were comprised of medications (36%), automotive products (14%), and cosmetics (14%). 26% of the exposures were treated in Emergency Departments and the remainder at home. 79% of the patients were asymptomatic or had only a mild outcome; 21% suffered moderate toxicity. Toxic exposures in motor vehicles pose a significant threat to both driver and occupants. Children are at high risk from products improperly stored in the car (shopping bags, purses, glove compartment) and resulting from the care giver's inattention while driving. These results can be used to promote community awareness of this problem.

Accidents↗

PubMed1989

Massive caffeine ingestion resulting in death.

Caffeine has long been recognized as an addictive substance with numerous toxic effects. Death due to caffeine overdose is rare, due in part to its marked gastric irritation resulting in spontaneous emesis. Caffeine can be found in food, beverages, analgesics, and over-the-counter weight loss products. We report a fatality resulting from the ingestion of mail order diet pills containing caffeine as their only active ingredient. A 22-year-old female arrived in the emergency department in cardiac arrest after ingesting these diet pills. Resuscitation efforts were unsuccessful. A serum toxicology screen revealed the presence of caffeine with a level of 1,560 micrograms/ml (lethal greater than 100 micrograms/ml). To our knowledge this is the highest reported fatal caffeine level. No other drugs were identified on the screen. Based on the absence of pathology on autopsy and the high caffeine level, death was attributed to acute caffeine toxicity. This case illustrates that deaths resulting from caffeine, although rare, continue to occur.

Adult↗

PubMed1988

Syrup of ipecac awareness: the use of a survey to direct future education efforts.

Syrup of ipecac awareness has been a major educational endeavor of our poison center for nearly 15 years. Educational efforts have been widespread and not directed specifically at any demographic population. A telephone survey was developed to determine our effectiveness in creating awareness and to identify demographic trends which would direct our future efforts. Respondents were randomly selected from the metropolitan telephone directory. Four hundred surveys were completed. The data was analyzed for statistical significance using chi square. The demographic background of the respondents compared favorably with that published by the Census Bureau. Fifty and six tenths percent were aware of syrup of ipecac. Age groups between 30-59 were more aware of ipecac than younger or older groups. Females were more aware of ipecac than males (37% vs 2%). There was a direct relationship between the number of years of education and ipecac awareness (college 62%, high school 49%, non-high school 37%). Married and divorced respondents had a higher awareness than single individuals (56% vs 38%). Respondents with working spouses had greater awareness than those with unemployed spouses (65% vs 43%). Twenty-four percent claimed to have ipecac in their home at the time of the survey. This provides significant insight for future direction with our educational efforts.

Adult↗

PubMed1988

Berry identification by emergency health care providers.

Emergency Department (ED) visits due to environmental toxins increase during summer and autumn months for multiple factors, including outdoor activities which permit proximity to wild berries and seeds. The Poison Center (PC) may be involved in this exposure by initial referral or by contact with emergency medicine personnel on patient arrival. Berry identification can be enhanced by considering the month and the basic berry description; positive identification can be made only be visual inspection. When, and if, the berry is identified, appropriate treatment can be instituted (as gastric emptying may not be indicated for every plant/wild berry ingestion). Regional AAPCC data was reviewed, and the most common berry exposures in this locale comprised the basis for the testing vehicle. Slides from the authors' collections were utilized in the examination. Examinees included emergency medicine physicians and nurses at an urban teaching hospital who attended a 40-minute presentation and discussion. Zero percent correctly identified all 10 specimens. Less than 10% of the berries were identified correctly by common name, and fewer examinees were able to correctly determine the presence/absence of potential toxicity. No difference in scores based on sex or professional experience was noted. An obvious implication is to increase emergency health care providers' education in locale-specific medical botany.

Emergency Medicine↗

PubMed1988

Hazardous Substance Center: a poison center's workers right to know program.

Workers Right To Know (WRTK) legislation has been enacted in several states. It is landmark advocacy legislation for employees and communities who may be exposed to hazardous chemicals, but it is also a complex and costly problem for business, industry, and nonprofit organizations. The Hazardous Substance Center (HSC), a division of the Pittsburgh Poison Center, was created to develop and implement programs to enable the business community to comply with the requirements of WRTK legislation. Specifically, the HSC provides the client with a 24-hour toxicology resource which objectively assists employees in the interpretation of the health-related effects information on material safety data sheets (MSDS) and assists them and medical professionals in the management of acute and chronic exposures. A variety of online databases and reference materials are utilized to respond to these inquiries. Each case is documented using the AAPCC Report Form. Data is analyzed to identify trends which can be used to assist the client in complying with the educational component. The HSC also provides a labeling program to the client to identify and classify hazardous substances. The service is provided for an annual contractual fee and creates an additional source of poison center revenue.

Humans↗

PubMed1988

Multiple vitamins and vitamins with iron: accidental poisoning in children.

To insure adequate nutrition, parents and pediatricians often advocate vitamin and mineral supplementation in young children. A retrospective review of 275 pediatric cases (6 mo-6 yr) involving multiple vitamins and vitamins with iron was conducted. Six cases with co-ingestants were excluded. The product ingested was the child's own dietary supplement in 93% of the cases. Fifty-six percent were children's multiple vitamins and 44% were children's multiple vitamins with iron. Adult vitamin preparations accounted for 7% of the ingestions. The average amount of vitamin A ingested by history was 43,300 IU (1,500-225,000) while the mean ingestion of iron was 16.8 mg/kg (0.9-77.5 mg/kg). Fifty ingestions (18.2%) involved more than one child. The mean time since ingestion was 15.8 min (0-150 min). Management data showed 246 (89.5%) being treated in the home setting with dilution (83%) or syrup of ipecac induced-emesis (10%). Medical intervention including emesis, serum iron/TIBC, and oral complexation was needed in 10.5% of the cases. The mean serum iron levels were 204.6 mcg/dl (81-414 mcg/dl). No patient needed admission. This review revealed 100% of patients showed no significant toxic effects. We conclude that early recognition and prompt treatment of pediatric overdoses involving multiple vitamins with and without iron significantly reduces morbidity.

Child↗

PubMed1988

Microfiche vs. computerized Poisindex: the impact on time management.

A prospective study was conducted to compare access-to-information times using Poisindex on microfiche versus the computerized version. A time study was conducted in 2 separate phases in the Pittsburgh Poison Center by professional time management engineers who observed certified poison information specialists. The microfiche phase was completed as a portion of a more extensive time management study, and the phase to evaluate the computerized version was completed 9 months after the system had been implemented to insure standardized competency. Access time was defined as the length of time required for the initial information to appear on either the microfiche viewer or the CRT. The average access time for microfiche use was 37.2 sec compared to 18.0 sec for the computerized version, an improvement of 106%. Based upon an annual volume of approximately 40,000 cases, the 19.2 sec savings in access time results in a time savings of 213 hours per year. To generate time savings equivalent to a 0.5 FTE position, a reduction of 1.47 min/call in the overall processing time is necessary. However, the time savings may improve patient care through easier and more extensive access to information and may allow more time for thorough documentation.

Information Systems↗

PubMed1988

The use of a scientific survey to direct poison center activities.

To develop a strategy for the development and implementation of future poison center services and prevention education activities, a telephone survey was conducted within the greater metropolitan region. The survey consisted of 58 questions developed to research information in 5 broad categories of consumer awareness of: poisoning accidents and their sources; Mr Yuk and the poison center; consumer response to poisonings; and education. The questionnaire was pretested and then conducted by experienced interviewers. Four hundred interviews were conducted over 12 consecutive days between the hours of 9:00 am and 8:00 pm to accomodate both working men and women. Respondents with a college education had significantly greater awareness of the poison center and Mr Yuk. Sixteen and 6/10 percent of the respondents had actually used the poison center. Homes with parents working outside of the home had a higher incidence of poisoning exposures. Respondents under 50 years of age had a significantly higher awareness of the poison center than those older than 50 (48% vs 27%). Furthermore, more respondents living in households of four or more knew about the poison center compared to smaller households (50% vs 36%). Only 5.5% of the respondents used the Mr Yuk sticker to obtain the telephone number of the poison center. Awareness of the poison center was 89.8%.

Data Collection↗

PubMed1988

Clinical toxicology literature: where is it?

Acquiring and continuously updating current literature from medical journals for a poison information center's (PIC) reference file is an essential, but difficult and expensive, task. Due to budgetary concerns and limited space, it is not feasible to purchase and store a large number of periodicals at a PIC. To determine, for acquisition purposes, which journals provide the largest number of clinical toxicology manuscripts, an extensive review of non-toxicology journals specializing in emergency medicine, pediatrics, pharmacology, and general medicine was conducted. Twelve issues of each journal were evaluated to identify citations pertaining to clinical toxicology (original research, reviews, case reports, letters, abstracts, editorials). One hundred seventy-four citations were identified. Emergency medicine journals accounted for 63% of the clinical toxicology citations, general medicine 18%, pediatrics 12%, pharmacology 5%, and miscellaneous 2%. Review articles and case reports comprised the majority of citations followed by original research, and letters to the editor. Forty percent of the citations were in Annals of Emergency Medicine, 22% in the American Journal of Emergency Medicine, and 7% in the American Journal of Medicine. Only a limited number of non-toxicology medical journals have a sufficient number of clinical toxicology citations in them to justify their purchase for a PIC.

Periodicals as Topic↗

PubMed1988

Quality assurance: how it can help a poison information center.

Quality assurance (QA) has become a benchmark program for health care in the 1980's. We have developed and implemented an innovative poison information center (PIC) QA program which includes: a peer review system of the PIC's medical records; a detailed routing system of medical records that allows for immediate access to cases involving business and industry accounts, on-going research, hospitalization, etc; and a standardized list of abbreviations for documentation of PIC medical records. The program additionally provides secondary gains of improving internal communications between the PIC staff and provides an excellent source of professional continuing education relative to poison management. QA is an essential program for all PIC's.

Medical Records↗

PubMed1988

The effects of penicillin and cephalosporin ingestions in children less than six years of age.

Oral antibiotic ingestions account for 1-2% of all pediatric exposures reported to regional poison information centers. The majority of these pediatric exposures involve the ingestion of penicillin or cephalosporin derivatives. How much can be ingested before gastric emptying is necessary is a controversial issue in the management of these cases. A study was designed to determine if children less than 6 years of age could safely ingest a maximum of 250 mg/kg of a penicillin or cephalosporin derivative without significant adverse effects. Sixty-one cases were prospectively collected. The average antibiotic amount ingested was 113.3 mg/kg (17.8-250.0 mg/kg). Each patient was evaluated for symptoms at the time of the initial call and at 6-12 degrees, 24 degrees, 48 degrees, and 72 degrees. Eighty-four percent of the children remained asymptomatic during the evaluation period. Eight of 13 symptomatic patients developed 1 or 2 episodes of diarrhea; 2 developed a rash. Amoxicillin suspension was involved in 70% of the cases, followed by cefachlor suspension 11%, and amoxicillin tablets 5%. Liquid preparations accounted for 90% of the cases and solid dosage forms, the remainder. The data strongly suggests that ingestions of less than 250 mg/kg of these products are not associated with significant outcomes and do not require gastric emptying.

Cephalosporins↗

PubMed1988

A poison center's emergency response plan.

Over 30 major chemical accidents have occurred in the tri-state area during the last decade. A recent incident involved a train which was carrying at least 5 toxic chemicals and was derailed in a heavily populated area causing 20,000 residents to be evacuated from their homes twice in 24 hr. In a 30-hr period over 900 calls were received at the poison center and approximately 80 people were examined at local health care facilities and treated for symptoms of toxic fume inhalation. This incident prompted the poison center to evaluate our emergency response capabilities. A strategy was developed to enable the poison center to deal with an increased call volume rapidly and effectively. Our Emergency Response Plan includes a chain of command for notification in the event of an anticipated increase in call volume; delineated responsibilities for medical, administrative, and professional staff members; designation of phone lines for incoming and outgoing calls; and a means of documenting both poison exposures and inquiries regarding the chemicals. So that staff members may report to the center without delay, child care provisions are also included. The development of the Emergency Response Plan, potential applications, and a synopsis of the aforementioned chemical spill will be discussed in detail.

Emergencies↗

PubMed1988

Identification of common houseplants in the emergent care setting.

One of the many bonds shared by poison center and emergency medicine staffs is the fear of plant misidentification. Although serious plant ingestions are uncommon, with all plant exposures totaling 8.3% of the American Association of Poison Control Centers' (AAPCC) 1985 data, it remains advisable to evaluate the ability of emergency medicine health care personnel to identify common houseplants and their toxic principles. Comparison of popular (based on sales) common houseplant lists obtained from two local nurseries and AAPCC 1985 reported plant exposure data enabled formulation of a 12-plant test vehicle. Specimens were photographed and the color slides viewed by the participants in a 40-minute presentation. Fifty-six health care professionals from 2 teaching institutions were tested. None of the participants (0%) were correct on all 12 specimens presented. Only 17% of the plants were identified correctly by common name. A mere 13% were correctly identified as being toxic or nontoxic. Although fewer females were tested (N = 14), they did better proportionately than males in visual identifications (28% vs 12% of all data points correct). Overall study results indicate a significant need for further staff education in medical botany and phytotoxins.

Emergencies↗

PubMed1987

In vivo effectiveness of oral complexation agents in the management of iron poisoning.

The accidental ingestion of iron-containing preparations is relatively common in children, as are intentional overdoses with iron in adults. One of the most commonly used treatment modalities is the use of orally administered sodium bicarbonate or sodium hydrogen phosphate, which is thought to render iron less soluble and bioavailable by converting it to ferrous carbonate or ferrous phosphate. An in vivo parallel study utilizing 3 groups of 50 male Sprague-Dawley rats was designed to evaluate the effectiveness of oral complexation agents at five distinct time points. Each animal group was dosed with 300 mg/kg ferrous sulfate (60 mg/kg elemental iron), followed by a 5% solution of either sodium bicarbonate, sodium dihydrogen phosphate, or a control of distilled water. The animals were anesthetized in each group at separate time points of 0, 1, 2, 4, and 6 hours post iron load, and blood samples were taken to determine serum iron levels. There were no differences in serum iron levels between the control group and either complexing agent. This suggests that oral complexation in iron poisoning may be ineffective.

Administration, Oral↗

PubMed1987

High pressure injection injuries: a serious occupational hazard.

High pressure injection equipment such as airless paint sprayers, high pressure grease guns, and fuel injection apparatus constitute a serious safety hazard resulting in significant morbidity. These devices are capable of delivering contaminants such as paint, solvents, and grease at pressures ranging from 600-12,000 psi. This allows the substance to penetrate through a minute skin wound and to spread widely through fascial planes and tendon sheaths and to produce significant vascular compression and systemic toxicity. High pressure injection injuries frequently result in amputation. Fifty-five suspected high pressure injection injury cases were evaluated. Twenty were determined to be actual injection injuries from equipment producing pressures in the range of 1,500-12,000 psi. The injected contaminants included latex paint, mineral spirits, and concrete sealer. Fourteen injuries involved digits. Digital amputation was necessary in three patients. Hospital admissions averaged 6.5 days. Successful management of these cases involves awareness of the impending problem and rapid referral of the patient to an emergency department and to a competent orthopedic or plastic surgeon.

Accidents, Occupational↗

PubMed1987

Poisoning in the elderly. An increasing problem for health care providers.

Crises related to older persons such as failing health, death of a spouse, and retirement may all be contributing factors responsible for increasing numbers of poisonings reported annually in the United States. A one-year retrospective analysis of poison exposures of persons 60 years of age and older revealed 75.2% were due to accidental circumstances compared to 87.4% of the total accidental cases. Intentional poisoning in the elderly was 20.6% contrasted to 11.3%. Adverse reactions to various products and drugs accounted for 2.0% in older persons as compared to 0.6% of total adverse reactions. Route of exposure in elderly poisonings contrasted by the total percent shows ingestion 71.4% versus 80.3%, inhalation 14.8% versus 5.2%, ocular contamination 5.3% versus 6.8%, and dermal exposure 5.2% versus 5.9%. Females aged 60 and over accounted for 63.4% as opposed to 46.7% of total female poisonings. Elderly males were 36.4% compared to 51.3% total males. Home management occurred in 39.1% of the elderly exposures as compared to 68.9% total poisonings managed at home. Medical intervention was needed in 56.0% of these older persons versus 29.8% of the total referred to health care facilities. Elderly admissions of 50.7% assimilates to 49.6% of total. Health care professionals must be cognizant of problems associated with poisoning in the elderly in order to develop strategies for prevention solutions.

Aged↗

PubMed1987

Effectiveness of 15-mL versus 30-mL doses of syrup of ipecac in children.

The rates at which 15- and 30-mL doses of syrup of ipecac induced emesis within 30 minutes were evaluated in pediatric patients treated for accidental poisoning. A two-year prospective study was conducted to collect data on 4306 pediatric patients (aged one to six years) who received syrup of ipecac to treat accidental poisoning. Patients received either 15-mL (during 1983) or 30-mL (during 1984) doses of syrup of ipecac and 120-240 mL of water or clear liquid. Time of administration and time of the first episode of emesis were reported by the person administering the syrup of ipecac; the difference between these times was recorded as the time to emesis. Successful emesis was defined as emesis within 30 minutes after ipecac administration, while failure was defined as emesis occurring more than 30 minutes after administration. Success and failure rates were compared using chi-square analysis. Syrup of ipecac 15 mL was administered to 1905 patients, resulting in a failure-to-produce-emesis rate of 8.82% (168 patients). Syrup of ipecac 30 mL was administered to 2401 patients, resulting in a 0.08% failure rate (two patients). A repeat dose of ipecac syrup in the 15-mL group yielded a 99.74% success rate, which was not significantly different from the 99.96% success rate after a single dose of 30 mL. Although syrup of ipecac dosing in pediatric patients is controversial, our data suggest that increasing the standard pediatric dose from 15 to 30 mL significantly reduces the emesis failure rate.

Child, Preschool↗

PubMed1987

Poison center value: an assessment by the professionals who use it.

Positive relationships between the poison center and hospitals are important to patient treatment. In order to effectively serve those health care facilities participating in such an interdependent relationship, it is necessary to evaluate dynamics at the interactive crux--the Registered Nurse (RN) and the Poison Information Specialist (PIS). To achieve this, a satisfaction, analysis/knowledge, and opinion questionnaire was designed and sent to RNs staffing Emergency Departments (EDs) and Intensive Care Units (ICUs) in the poison center service area. 518 RNs responded for a 55% response rate. One hundred percent of the 40 ED nursing managers responding consider the poison center of great or significant value in toxicologic management in both theory and experience. Seventy-one percent assert it is of great assistance in actual practice. Greater than 95% of the 134 staff ED Rn's responded in a similar manner. Slightly more than 85% of all surveyed felt that they communicate with a PIS; however, their perception of the professional training of the PIS varied from that of an operator to an administrative staff person. A variety of other questionnaire data is addressed. Application of this information to education/reeducation will promote improved communication and compliance with consumer hospitals, particularly those contributing financially to the poison center.

Attitude of Health Personnel↗