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Biomedical subjects

L Goldfrank

Publications and source records attributed to L Goldfrank.

At least 19 recordsLinked to original sources
PubMed1999

Emergency center categorization standards.

The SAEM EC Categorization Task Force was developed in response to the 1994 Macy Foundation's recommendation that emergency medicine (EM) organizations "should revise the classification of emergency departments ... to reflect the level of care available in emergency departments, and indicate whether or not facilities are adequate and whether appropriately qualified and credentialed emergency physicians are available 24 hours a day." By holding Level 1 emergency centers (ECs) to objective standards based on the quality of care delivered as well as administrative, research, and educational efforts, SAEM hopes to improve patient care. The SAEM EC Categorization Task Force is now beginning the process of reviewing ECs that provide comprehensive emergency care and serve as regional resources for education, research, and administration in EM. This standards document describes relative and critical criteria to be met in order to receive designation as a Level 1 emergency center. Such centers must meet all critical criteria, and be in sufficient compliance with most or all relative criteria, in order to achieve this designation. This process is entirely voluntary. Any EC is eligible for review. Any institution can initiate the review process by applying. Application materials and further information, including the policies and procedures of the SAEM EC Categorization Task Force, are available from SAEM.

Education, Continuing↗
PubMed1996

Pharmacokinetics of extended relief vs regular release Tylenol in simulated human overdose.

BACKGROUND: The purpose of this trial was to compare the pharmacokinetics of the two available acetaminophen dosage forms in simulated human overdose. METHODS: Ten healthy volunteers received acetaminophen, 75 mg/kg orally, either as the regular release or extended relief formulation in a random, crossover fashion. Blood samples were analyzed using a TDx assay and a best fit correlation of data points was determined by PCNONLIN. RESULTS: The area under the curves for extended relief acetaminophen and regular release acetaminophen were 426 mg h/L and 432 mg h/L, respectively (p = 0.768). The mean half times for extended relief acetaminophen and regular release acetaminophen were 4.02 h and 2.56 h, respectively (p < 0.001). The mean maximum serum acetaminophen concentrations were 62.6 mg/L (414.4 mmol/L:) and 94.3 mg/L (624.3 mmol/L) for extended relief acetaminophen and regular release acetaminophen, respectively (p < 0.001) and the mean time to maximum serum acetaminophen concentrations were 0.87 h and 0.75 h for extended relief acetaminophen and regular release acetaminophen, respectively (p = 0.508). CONCLUSIONS: Although the formulations appear to have equal bioavailability, their half-lives and peak concentrations were significantly different. Further study is required to determine whether these differences affect the assessment and management of poisoned patients.

Acetaminophen↗
PubMed1995

Tuberculosis in the HIV-infected patient.

After decades of decline, tuberculosis has emerged as a global health challenge. In the setting of HIV immunocompromise, TB occurs frequently, early, and often atypically. New infections can take an accelerated course. The usual tests for diagnosing Mycobacterium tuberculosis infection are less sensitive when CD4+ counts are low. Increased prevalence of treatment failure, drug-resistant strains, and nosocomial transmission of multidrug-resistant TB are discussed as are new diagnostic tests that will accelerate the time to diagnosis and allow better epidemiologic tracking. Early recognition, isolation, appropriate therapy, and environmental controls that will protect staff and patients from the risk of exposure are also described.

AIDS-Related Opportunistic Infections↗
PubMed1991

Morphine-ethanol interaction on body temperature.

1. The interaction between ethanol and morphine on core temperature was investigated in Swiss Webster mice. 2. Morphine (2.5-30 mg/kg) and ethanol (0.5-3.0 mg/g) administered individually resulted in a dose dependent decrease in body temperature. 3. When both drugs were injected simultaneously, body temperature decreased less than it would be expected to if the effects were additive. 4. Naloxone antagonized the hypothermic effect of morphine, but the hypothermic effect of ethanol and that of the combination of morphine plus ethanol was only reversed with high doses of naloxone (10 mg/kg). 5. Individual morphine and ethanol plasma levels were not significantly altered by their concomitant administration. 6. Binding of tritiated naloxone to opiate receptors in mouse brain membrane preparations was unchanged by pretreatment with ethanol (0.5 and 2 mg/g). 7. The interaction between morphine and ethanol was found to be less than additive and not related to pharmacokinetic changes of either drug.

Animals↗
PubMed1990

The medical complications of drug abuse.

There is a vast array of abused drugs, and only a few of the more commonly used substances have been discussed. Patients with drug abuse frequently present with atypical syndromes and diseases. These individuals usually have less social, medical and economic support, making them more susceptible to the diseases that are associated with poverty, such as tuberculosis, and the complications of diseases such as hypertension, congestive heart disease and diabetes that require long-term care. Our strategy in the evaluation of these patients should consider all these aspects of medicine. A meticulous assessment and comprehensive care are necessary to render quality care for these complicated human and toxicological problems.

Administration, Inhalation↗
PubMed1987

Hematologic aspects of toxicology.

Exposure to a number of toxins may result in a variety of hematologic abnormalities. Derangements of the synthesis of cellular elements, a shortened red cell half life, abnormalities of coagulation, and interference in oxygen-carrying capacity are some of the pathologic effects. Pharmacologic agents, heavy metals, and animal and insect venoms are among the toxins implicated in the production of hematologic abnormalities. This article focuses on some of these issues.

Blood↗
PubMed1986

The bodystuffer syndrome: a clandestine form of drug overdose.

The case histories of five people who ingested drugs in an attempt to conceal illegal substances when they were confronted by police are reported. They presented to an emergency department in various clinical states ranging from asymptomatic to comatose. This syndrome has been called "bodystuffing" by the authors, who differentiate it from "bodypacking," which is the ingestion of drugs for the purpose of smuggling. Bodystuffers may ingest one or more drugs, usually deny the ingestion, and are often not discovered until symptoms develop. Bodystuffers tend to be known drug dealers and are often drug abusers themselves. The ingestion is often unsuspected by authorities, but the act may also be witnessed but regarded as trivial. A common scenario is that of a person who is in an asymptomatic state when arrested and is later found comatose in jail. A variant of the syndrome is the ingestion of drugs to produce a medical condition that could defer incarceration.

Adult↗
PubMed1986

Esophageal tear following forceful removal of an impacted oral-gastric lavage tube.

We report an unusual complication of oral-gastric lavage in a drug overdose patient. During the lavage procedure, the oral-gastric tube became impacted in the esophagus. Forceful removal of the tube resulted in an esophageal tear. The patient did well with conservative management and was discharged with no long-term sequelae.

Administration, Oral↗
PubMed1986

A dosing nomogram for continuous infusion intravenous naloxone.

Naloxone hydrochloride is extremely valuable for diagnosing and managing the opioid overdose. Due to naloxone's short half life and a long duration of action of most opioids, repeated naloxone dosing often is required to prevent the recurrence of respiratory depression. An alternative to repeated bolus administration is a continuous IV infusion. We conducted a two-phase study to determine the pharmacokinetics of naloxone and to develop a continuous dosing nomogram. In the first phase seven patients were given an IV bolus dose alone and serial plasma naloxone levels were determined. Naloxone elimination was found to be biexponential with the mean beta half life equal to 0.023 +/- 0.002 reciprocal minutes in two patients and 0.015 +/- 0.02 reciprocal minutes in five patients. In the second phase ten volunteers were given either a 2-mg or a 4-mg bolus dose followed by a 1.5-mg/hr or a 3-mg/hr continuous infusion. The mean volume of distribution of the central compartment was found to be 0.806 +/- 0.408 L/kg. The mean beta rate constant of elimination was found to be 0.036 +/- 0.027 reciprocal minutes. A computer simulation of the pharmacokinetic parameters determined in our study found that a continuous infusion of two-thirds of the bolus dose that resulted in reversal each hour will maintain the plasma naloxone levels equal to or greater than the naloxone levels that would have existed 30 minutes following the bolus dose.

Adult↗
PubMed1985

Gastrotomy--a surgical approach to iron overdose.

Emesis and lavage often are ineffective in providing complete emptying of the stomach after an ingestion. With a locally corrosive and systemically toxic agent such as iron, surgical intervention with emergency gastrotomy may be required. We recently treated a 19-year-old man in the ED and in the departments of surgery and medicine who required a gastrotomy to remove a large amount of elemental iron inaccessible to removal by emesis, lavage, or gastroscopy. At gastrotomy the stomach showed full-thickness inflammation; the entire mucosal surface was hemorrhagic in nature. Gastrotomy was successful in allowing the removal of a large amount of the retained corrosive material. The severity of the findings at gastrotomy and the dramatic clinical improvement and recovery in our patient strongly support this approach if traditional methods fail.

Adult↗