Search PubMed⌕ Search

Biomedical subjects

F Harchelroad

Publications and source records attributed to F Harchelroad.

15 recordsLinked to original sources
PubMed1992

Container residue after activated charcoal administration in the emergency department.

We hypothesized that sources of activated charcoal (AC) used as a form of gut decontamination in the treatment of drug overdose may deliver significantly less charcoal than expected because of retained charcoal and sorbitol (ACS) from the treatment of 50 consecutive overdose patients were collected. Health care personnel delivering the dose were unaware of the study hypothesis. A total of 82 containers were obtained in this manner. Each container was labelled to contain 25 g AC and 48 g sorbitol. Five unused containers of ACS were obtained as controls. Each container was thoroughly cleaned, and the contents vacuum filtered and washed with 1 L of tap water. The tared filter paper and charcoal was dried for 24 h and weighed. The average amount of charcoal retained in each used container (retained) was 0.549 g (range 0.318-1.637 g). This accounts for 2.2% of the 25 g dose expected to be delivered. The average amount of charcoal found in each unused container (actual) was 25.892 g. The delivered dose (actual minus retained) may be calculated as 101.4% of the expected 25 g dose. When using this formulation of ACS there is no significant difference between the amount of charcoal given to an overdose patient and the amount ordered for gut decontamination. Despite the poor suspension of charcoal in sorbitol and the less than ideal conditions under which it is given, the patient receives an adequate dosage of AC if it is ordered.

Adolescent↗
PubMed1991

Toxicology screening of the trauma patient: a changing profile.

STUDY OBJECTIVES: To determine the current ingestants found in the multiply injured trauma patient and to determine if this select group of ingestants affected the resuscitation, evaluation, or convalescent management of these patients. DESIGN: A one-year retrospective analysis was performed on all patients who were admitted to an urban trauma center with a discharge diagnosis of multiple trauma and who received a comprehensive toxicology screening test. MAIN RESULTS: One hundred twenty-seven of the 177 patients (72%) who fulfilled the criteria had positive toxicology screens. Ethyl alcohol was the only drug present in 26 of these patients (20%); 57 (45%) were positive for drugs other than ethyl alcohol. A combination of ethyl alcohol and at least one other drug was quantified in 44 patients (35%). The most often encountered substances were ethyl alcohol (55%), marijuana (24%), and cocaine (21%). Twelve drug screens (9%) demonstrated pharmaceuticals (eg, acetylsalicylic acid, acetaminophen, or cyclic antidepressants) that may require specific antidotal treatment. CONCLUSION: The ingestant profile found in this subgroup of trauma patients differed from those of previous studies. Although a select group of these ingestants requires specific treatment or affects the physical assessment of the patient, none of these trauma patients received more than supportive care.

Emergencies↗
PubMed1991

China White epidemic: an eastern United States emergency department experience.

STUDY OBJECTIVE: The purpose of this study was to isolate significant clinical or demographic findings concerning overdose patients treated during a China White (3-methyl fentanyl) epidemic and compare them with data for all unintentional narcotic overdose patients during a 24-month period. DESIGN: We reviewed charts from 85,246 patient visits to our emergency department during the 24-month period of January 1987 through December 1988 to study this narcotic epidemic. Data from the Allegheny County Coroner's Office pertaining to unintentional drug overdose deaths that occurred during this same period also were reviewed. SETTING: The first outbreak of narcotic overdoses in the eastern United States involving China White occurred in Allegheny County, Pennsylvania, in 1988. TYPE OF PARTICIPANTS: Patients were included if they met the criteria of a suspected unintentional narcotic overdose, but excluded if they were not given naloxone. INTERVENTIONS: Emergency physicians became suspicious of China White use after an unusual increase in narcotic overdoses presenting to the ED coupled with "routine drug of abuse" screens negative for opiates despite dramatic patient responses to naloxone. In most of the cases in which specific testing was done, there were positive indicators of fentanyl derivatives. Investigations found China White present in street drugs and paraphernalia. MEASUREMENTS AND MAIN RESULTS: A cluster was defined as a time period with a statistically significant increase in overdoses over the expected number for an interval of equal length. Although there were no significant clinical differences in case presentation during the 24-month period, there was a statistically significant 13-fold increase in overdoses during the September through November 1988 cluster (mean, 13 vs 0.95 per month, P less than .001 by Wilcoxon rank-sum test). A dramatic increase in unintentional drug overdose deaths occurred in the county during this cluster. A total of 18 fentanyl-positive unintentional drug overdose deaths, predominantly male (89%) and black (56%), with an age range of 19 to 44 years (mean, 34.9 years), were reported by the county coroner (13 during the cluster). Narcotic overdoses and unintentional drug overdose deaths declined sharply with confiscation of a clandestine China White laboratory. CONCLUSIONS: China White was responsible for a dramatic rise in unintentional drug overdose deaths in Allegheny County in 1988. There were no significant clinical differences between China White overdose survivors and other unintentional narcotic overdose victims. Overdoses responsive to naloxone with inconsistent routine toxicologic screens may be due to a fentanyl analogue.

Adult↗
PubMed1991

Flumazenil for the reversal of refractory benzodiazepine-induced shock.

Benzodiazepines are known to cause central nervous system and centrally mediated cardiovascular depression. The benzodiazepine antagonist flumazenil has been shown to antagonize benzodiazepine-induced central nervous system depression. We report a case in which cardiovascular depression secondary to benzodiazepine use was reversed by this agent.

Aged↗
PubMed1990

Treated vs reported toxic exposures: discrepancies between a poison control center and a member hospital.

Statistics accumulated by Poison Control Centers (PCC) are routinely used on the local, regional and national levels by governmental agencies to set policy and direct funding. Incomplete reporting by member hospitals is recognized by PCC as a factor contributing to discrepancies in epidemiological estimates; however little emphasis is classically placed by the PCC on expanding reporting from member hospitals. A 1y retrospective review of patients with toxic exposure presenting to an urban Emergency Medicine Department (EMD) was performed to quantify the lack of concordance between treated and reported toxic exposures. 470 toxic exposures presented over the study period, of which only 123 (26%) were relayed to the regional PCC. Inhalation exposures were least likely to be referred for PCC consultation (3%); whereas PCC consultation was obtained for 33% venomous snake bite cases, and 95% of the cyclic antidepressant ingestions. Clusters of similar exposures resulted in fewer PCC consultations. Understanding each hospital's "profile" for handling toxic exposures, and individualized advertisement by the PCC to their member hospital may increase their data reporting. The statistical significance of their epidemiological studies as well as their revenue may increase.

Environmental Exposure↗
PubMed1989

Emergency department sonography by emergency physicians.

A retrospective study was conducted to examine whether emergency physicians can perform accurate ultrasonography that influences the diagnosis and treatment of selected disorders in the emergency department (ED). The physicians acquired a moderate level of expertise in sonography using a series of practical demonstrations and lectures. Patients with symptoms suggestive of cardiac, gynecologic, biliary tract, and abdominal vascular disease periodically underwent ED sonography. The initial interpretation was used as a diagnostic adjunct to subsequent therapy. The accuracy of positive sonographic findings was assessed by confirmatory testing, formal review, or confirmatory clinical course. Emergency physicians were able to diagnose correctly (1) the presence and approximate size of pericardial effusions, (2) the presence or absence of organized cardiac activity in patient with clinical electrical mechanical dissociation, (3) the presence or absence of intrauterine pregnancy in pregnant patients with lower abdominal/pelvic complaints, (4) the position of intrauterine devices in patients with suspected uterine perforation, (5) the presence of gallstones in patients with suspected biliary tract disease, and (6) the presence and size of abdominal aortic aneurysms in patients with pulsatile masses or unexplained abdominal pain. It was concluded that reliable sonography which influences diagnosis and therapy can be performed by emergency physicians and that sonography should become a standard procedure in EDs.

Aorta, Abdominal↗
PubMed1989

Gastrointestinal transit times of a charcoal/sorbitol slurry in overdose patients.

Gut decontamination with a slurry of activated charcoal and sorbitol is one of the methods presently available to decrease total body burden of ingested drug. This one year retrospective audit of patients presenting with a history of recent toxic ingestion was designed to determine the time to stool of a charcoal/sorbitol slurry (CSS) when used for differing ingestants. A total of 69 patients received a CSS. 50.7% took less than 6 hours for their first charcoal stool, while 26.1% had emesis of the CSS within 30 minutes of administration. Ingestion of drugs which may increase gastrointestinal transit time (i.e. opioids, cyclic antidepressants) correlated with prolonged time to stool despite treatment with the CSS. Though a prospective, controlled study needs to be performed, variation in dosage of the CSS may be appropriate in select patient groups to offset the effects of the ingestant on bowel motility.

Adolescent↗
PubMed1989

Poison center utilization in nosocomial toxicologic exposures: a prospective study.

Accidental toxicologic exposures that occur within health care facilities (HCFs) have the potential to increase morbidity and mortality as well as enhance medicolegal liability. By contacting the poison center immediately on recognition of these events, health care providers may ultimately lessen eventual toxic effects through appropriate intervention. Exposures of this nature reported to the poison center over a 12-month period were collected and tabulated for specific occurrences. Six categories of therapeutic mis-adventure were delineated: 1. Right patient/wrong medication (18%); 2. Right patient, right medication/wrong dose or route (16%); 3. Lack of patient education (2%); 4. Proximity of potentially harmful substances to confused persons (54%); 5. Incorrect equipment management (6%); and 6. Pharmacologic treatment based on lab error (4%). This study seeks to increase awareness of poison center ability to assist in management of the "therapeutic misadventure".

Adolescent↗
PubMed1989

Poison center utilization in nosocomial toxicologic exposures: a prospective study.

Accidental toxicologic exposures that occur within health care facilities (HCF's) have the potential to increase morbidity and mortality, as well as enhance medicolegal liability. By contacting the poison center immediately on recognition of these events, health care providers may ultimately lessen eventual toxic effects through appropriate intervention. Exposures of this nature reported to the poison center over a twelve month period were collected and tabulated for specific occurrences. Six categories of therapeutic misadventure were delineated: Right patient/wrong medication (18%); Right patient, right medication/wrong dose or route (16%); Lack of patient education (2%); Proximity of potentially harmful substances to confused persons (54%); and Incorrect equipment management (4%). This study seeks to increase awareness of poison center ability to assist in management of the "therapeutic misadventure."

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

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↗
PubMed1986

Bicarbonate.

Bicarbonate is a laboratory value of considerable importance in emergency medicine. It is essential in the diagnosis of acid-base disorders, but must be interpreted in the context of a number of other parameters, including electrolytes, arterial blood gases, and renal function. As most laboratory evaluations, its prime importance is confirmation of impressions drawn from the history and physical examination. Still, in the emergency department, it is frequently found as an unsuspected component of a variety of pathologic processes. Except in extreme deviations from the normal range, the clinician is encouraged to seek an understanding of primary and compensatory processes before the initiation of therapy.

Acid-Base Equilibrium↗