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Biomedical subjects

S W Borron

Publications and source records attributed to S W Borron.

At least 37 records · Page 2Linked to original sources
PubMed2000

Radiopacity of clomipramine conglomerations and unsuccessful endoscopy: report of 4 cases.

BACKGROUND: The radiopacity of ingested substances may serve as a clue to the presence of particular compounds, as this characteristic varies considerably among medications and household products. Tablet conglomerations are also variably radiopaque. We report 4 cases of clomipramine poisoning associated with formation of radiopaque masses, believed to be clomipramine, in the area of the stomach. CASE REPORTS: Four patients were admitted to the Toxicological Intensive Care Unit after ingestions of, respectively, 8.5 g (180 tablets of mixed strength), 7.5 g (100 tablets), 10.5 g (140 tablets), and 4.5 g (60 tablets) of clomipramine, along with other sedatives and antipsychotics. In each case, a rounded density was observed in the gastric area on plain chest radiograph. The hospital courses of each patient were marked by tachycardia, hypotension, QRS and QT prolongation, seizures, and decreased mental status. Three of 4 patients underwent unsuccessful endoscopy to remove tablet fragments and subsequently suffered gastrointestinal hemorrhage requiring transfusion. All patients were discharged recovered from the hospital. DISCUSSION: Clomipramine, a potent tricyclic antidepressant, has been previously reported to be nonradiopaque, and has not been reported to induce formation of concretions. These cases suggest that massive ingestions of clomipramine may form bezoars which are radiopaque and may be associated with serious toxicity. Careful consideration should be given prior to the use of gastric endoscopy for the retrieval of tablet fragments since significant hemorrhage, attributed to the procedure itself rather than to clomipramine toxicity, may ensue.

Acepromazine↗
PubMed2000

Are poisonings inflicted upon others always criminal?

While self-poisoning is a common cause for hospitalization, in the experience of our toxicological intensive care unit and emergency department, poisoning of other persons appears to be quite rare. We identified 32 patients in a non-exhaustive review of patients presenting over a 28-y period who had been unequivocally poisoned by others. We examine here the circumstances leading up to these poisonings, along with their clinical outcomes, and propose a classification scheme based on underlying intent.

Adult↗
PubMed1999

Emergency department hazardous materials protocol for contaminated patients.

Emergency department handling and treatment of chemically contaminated patients can have potentially serious consequences. Medical staff can be exposed to hazardous chemicals through dermal contact or inhalation of volatile compounds or particulate matter. Exposure can result in symptomatic illness from either a direct chemical toxic effect or an odor-mediated psychologic response. Either situation can severely affect ED function and lead to facility evacuation. The Joint Commission on Accreditation of Healthcare Organizations standards and the Occupational Safety and Health Administration regulations for participation in community hazardous materials incident emergency response plans require hospital EDs to prepare for hazardous materials incidents. This study provides a template protocol for ED preparation for and treatment of patients exposed to hazardous materials.

Clinical Protocols↗
PubMed1999

Assessment of erythrocyte cholinesterase activity in victims of smoke inhalation.

BACKGROUND: The nature of the toxic gases that cause death from smoke inhalation is incompletely understood, and the mechanisms leading to incapacitation remain to be determined. Thermal degradation products of various compounds, including phosphorous-based fire retardants, are suspected capable of impairing human cholinesterase activity. The aim of this study was to measure the erythrocyte cholinesterase activity in victims of smoke inhalation. METHODS: We prospectively measured the erythrocyte cholinesterase activity in blood samples obtained at the scene of residential fires from 49 fire victims. We compared the results with those in an unmatched group of 45 persons with acute drug poisoning. RESULTS: The median (25th-75th percentiles) erythrocyte cholinesterase activity in the 49 fire victims, 1968 IU/L (1660-2276), was significantly lower than in the 45 control subjects 2460 IU/mL (1968-2890), (p = 0.0004). There was no significant difference of the red blood cell counts or plasma protein levels between the 2 groups, while the hematocrit was significantly greater in the fire victims than in the drug-poisoned patients. There was a significant correlation between blood cyanide and carbon monoxide concentrations in the fire victims (r = 0.494, p = 0.002). There was no correlation between erythrocyte cholinesterase activity and either blood cyanide (r = 0.11, p = 0.44) or blood carbon monoxide concentrations (r = 0.04, p = 0.78). CONCLUSIONS: We found a significantly lower level of erythrocyte cholinesterase activity in victims of residential fires, when compared with a convenience sample of hospitalized poisoned patients. Despite the limitations of the study, investigations of the toxic gases potentially responsible for impairment of cholinesterase activity and the clinical significance of this lower enzymatic activity merit further investigation.

Adult↗
PubMed1999

Ferrocyanide ingestion may cause false positives in cyanide determination.

CASE REPORT: The authors present a patient who ingested a cyanide containing solution and arrived at the hospital without any clinical evidence of intoxication but an elevated blood cyanide level. The authors explain this discrepancy with the following hypotheses: 1) the patient ingested cyanide as an iron-chelated complex; and 2) the sulfuric acid used in the standard microdiffusion technique released cyanide from its iron-bound state to result in the observed elevated blood cyanide. Through a series of in vitro analyses, the authors demonstrate the following: 1) the ingested solution tested positive for cyanide with the sulfuric acid technique and negative for cyanide with acetic acid; 2) the presence of a ferrous salt in the ingested product by a colorimetric redox titration technique; and 3) release of a small fraction of the total cyanide from ferrocyanide by the sulfuric acid technique. The authors conclude: 1) the patient ingested potassium ferrocyanide; and 2) the strong acid used in the cyanide microdiffusion assay will liberate cyanide that is chelated to iron to yield false positive results.

Adult↗
PubMed1999

Relation of body position at the time of discovery with suspected aspiration pneumonia in poisoned comatose patients.

OBJECTIVE: The left lateral decubitus position is generally accepted as the position of choice to protect against aspiration pneumonia in comatose poisoned patients. We studied the relationship between initial body position during coma and subsequent development of suspected aspiration pneumonia (SAP). DESIGN: Observational, descriptive study. SETTING: Toxicology intensive care unit in a university hospital. PATIENTS: Acutely poisoned comatose patients admitted to our intensive care unit. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Glasgow Coma Scale score (GCS) and body position were recorded in poisoned patients on discovery. Chest radiographs were examined for infiltrates suggesting SAP within 24 hrs of hospitalization. The prone positioned patients had a lower incidence of SAP than patients in the lateral decubitus and supine positions, despite similar GCS scores. Patients in the semi-recumbent position had an incidence of SAP similar to prone patients, but with higher GCS values. CONCLUSIONS: The prone position appears to be associated with a lower incidence of SAP than the lateral decubitus position in comatose poisoned patients.

Acute Disease↗
PubMed1999

Delayed transient loss of consciousness in acute carbon monoxide intoxication.

In acute carbon monoxide intoxication the presence of altered consciousness, ranging from transient loss of consciousness to coma, represents a poor prognostic factor and modifies the approach to therapy. Transient loss of consciousness is, as a rule, contemporaneous to the exposure, generally occurring at the scene of the intoxication. We report an unusual case of delayed transient loss of consciousness, occurring in the absence of any other evident aetiology, in one member of an orchestra composed of 110 members after a mass carbon monoxide poisoning.

Acute-Phase Reaction↗
PubMed1999

Chlorpyrifos: a ten-year US poison center exposure experience.

We performed a retrospective review of data based on poison center exposure inquiries related to chlorpyrifos (CP) and the corresponding poison center-determined medical outcomes reported to the Toxic Exposure Surveillance System (TESS) of the American Association of Poison Control Centers. Ten y (1985-1994) of TESS data were obtained. Medical outcomes representing all inquiries, accidental/unintentional inquiries, and intentional/suicidal inquiries were tabulated. Published TESS data was also tabulated to allow comparison of CP exposure inquiries to all non-pharmaceutical and insecticides/pesticides exposure inquiries for like time periods. Frequency of antidote use, product sales data, CP-related fatality reports, and pertinent issues related to telephone derived surveillance data were also reviewed; 36, 183 CP exposure inquiries were identified. Of all CP exposure inquiries, 27, 473 (75.9%) were assessed as having no significant health consequences; 4,511 (12.5%) outcomes were judged unrelated and 2,980 (8.2%) were unable to be followed. Reported significant medical outcomes for the remaining exposure inquiries were moderate 1,092 (3.0%), major 119 (0.3%) and death 8 (0.02%). Considering only calls with outcomes judged causally related to CP, where a given level of effect could reasonably be determined, 95.8% (27,473/28,692) of these calls resulted in no significant health effects. Use of antidotes specific to organophosphates were infrequent [atropine, 1.0% (385) and 2-PAM, 0.5% (177) of all cases respectively]. Despite the number of reported CP exposure inquiries, relatively few resulted in outcomes of consequence. TESS data suggested that the majority of patients undergoing medical evaluation and/or treatment after a suspected CP exposure do not require specific antidotes. TESS data serves as a useful first step in evaluating product safety. Assessment of product toxicity requires additional investigation of reported adverse effects and circumstances related to the incident.

Chlorpyrifos↗
PubMed1998

Lingual angioedema after perindopril use.

We report a case of severe lingual edema and airway compromise associated with angiotensin-converting enzyme inhibitor use. Although angiotensin-converting enzyme inhibitors are generally considered as safe drugs, angioedema may induce severe respiratory distress and death.

Angioedema↗
PubMed1998

Prolonged severe hypercapnia complicating near fatal asthma in a 35-year-old woman.

OBJECTIVE: We describe a patient with a prolonged and severe hypercapnia occurring during an episode of status asthmaticus induced by ophthalmic instillation of carteolol. SETTING: Prehospital Emergency Medical Service and Pulmonary Intensive Care Unit in a university hospital. PATIENT: A 35-year-old female developed an acute asthma attack while at home, which required advanced life support. INTERVENTION: On hospital admission, arterial blood gases revealed a PaCO2 of 208 mmHg. Hypercapnia persisted with a PaCO2 of more than 190 mmHg for 10 h, with pH always less than 7.00. The patient was finally discharged after 26 days without sequelae. CONCLUSION: This case illustrates the cerebral and cardiovascular tolerance of severe and prolonged hypercapnia associated with major acidosis.

Acidosis, Respiratory↗
PubMed1998

Intubation difficulty in poisoned patients: association with initial Glasgow Coma Scale score.

OBJECTIVE: To determine whether the initial Glasgow Coma Scale (GCS) score is predictive of intubation difficulty in out-of-hospital airway management of poisoned patients. METHODS: A prospective, observational study was performed in a toxicological intensive care unit of a university hospital and in a physician-based out-of-hospital care system. Subjects included consecutive poisoned patients intubated during their airway management by out-of-hospital medical teams before hospitalization. The intubating operator (emergency physician or nurse anesthetist) completed a 1-page checklist concerning the clinical parameters and circumstances (nature of sedation and difficulty) of endotracheal intubation upon hospital arrival. RESULTS: Forms were completed for all 394 consecutive out-of-hospital intubations. The patients ranged from 15 to 95 years of age (median age 38 years). Most (96%) of the intubations were via the oral route. Intubation difficulty was related to GCS values. Intubation difficulty was seen more often in patients with 7 < or = GCS < or = 9 (36%) than in patients with GCS < 7 (15%) or > 9 (10%). Not surprisingly, perceived intubation difficulty was least for those patients undergoing rapid-sequence intubation rather than administration of sedation alone. CONCLUSION: Maximum difficulty of intubation is encountered in poisoned patients with 7 < or = GCS < or = 9. Intubation of such patients appears to be facilitated by appropriate sedation and/or neuromuscular blockade.

Adolescent↗
PubMed1998

A survey of sedation protocols used for emergency endotracheal intubation in poisoned patients in the French prehospital medical system.

The purpose of this study was to evaluate prehospital sedation protocols used by several French mobile intensive care units for difficult intubations in poisoned patients. This prospective, descriptive study was performed within the toxicological intensive care unit in a university hospital. Consecutive poisoned patients intubated during their airway management by prehospital medical teams were included. Intubating physicians completed a one-page checklist concerning the circumstances of endotracheal intubation. Intubation difficulty was significantly related to the nature of sedation protocols. The use of etomidate alone as an intubation sedative agent was associated with significantly poorer intubating conditions (47.2% difficult) than other sedative agents or neuromuscular blockade). Neuromuscular blockade with sedation in our series was associated with the lowest incidence of difficult intubations in poisoned patients. Sedation alone for intubation appears to be inadequate to achieve good intubating conditions in a significant proportion of patients.

Adult↗
PubMed1997

An early study of pulmonary asbestosis among manufacturing workers: original data and reconstruction of the 1932 cohort.

A cross-sectional prevalence survey of asbestosis, including all 1,140 employees of a diversified asbestos products manufacturer, was conducted in 1932 by Drs. Anthony J. Lanza and Frank V. Meriwether. Occupational histories were obtained from workers in order to identify job tasks with exposure to asbestos and other fibrogenic dusts. Abbreviated medical histories, physical examinations, fluoroscopy, and chest radiographs were performed. Radiographs were interpreted according to applicable criteria for pneumoconiosis, the presence of which was confirmed in 327 subjects (29%). Among those, 64% had previous exposure to dusts in addition to asbestos, coal being the leading non-asbestos exposure. Thirty-six percent of cases had prior exposure only to asbestos dust. The original conclusions do not survive. Contemporaneous related documents suggest that the original authors believed asbestosis to be a milder form of lung disease than silicosis. It was subsequently recommended that the company institute pre-employment physicals, including chest radiographs; not hire people with prior coal-dust exposure; warn workers against excessive exposure to asbestos dust; remove those with disease to less dusty areas; and begin periodic medical surveillance for pneumoconiosis. The study, which has never appeared in the medical or scientific literature, holds important lessons for those concerned with occupational health today and in the future.

Asbestosis↗
PubMed1997

Optimization of glottic exposure during intubation of a patient lying supine on the ground.

Two methods of endotracheal intubation of patients lying on the ground were compared for ease and speed of intubation and minimization of complications in a crossover study of prehospital-oriented emergency physicians. Intubation of a mannequin was attempted by the physicians in either a left lateral decubitus (LLD) position or a kneeling (K) position, followed by the alternate position. The LLD position afforded more rapid intubation, better glottic visualization, and less dental trauma. Eighty-seven percent of physicians completely visualized the glottis in the LLD position, versus 33% of the K position group. Intubation times were 10.5 versus 14.6 seconds in the LLD and K positions, respectively (P < .001). The LLD position is a more effective position (in a mannequin model) than the K position for intubation of patients found lying on the ground, a frequent situation in prehospital care.

Cross-Over Studies↗